OASIS Alert

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If you aren't using these pressure ulcer prevention best practices, you may be risking your patients' health and your agency's reputation.

Although most pressure ulcer prevention and treatment tools have been developed for nursing homes, home health agencies are about to become more accountable, with OASIS C process measures taking effect in January 2010.

Use these best practices from the quality improvement organization Quality Insights of Pennsylvania to look at your agency's policies and processes to see how you measure up:

• Do a skin risk assessment on admission/readmission and every week x 4.

•Assess for intrinsic factors that put patients at a higher risk of pressure ulcer development.

• Assess skin risk quarterly and with change in condition.

• Implement interventions related to skin risk assessment.

• Develop policies, procedures, and protocols consistent with current standards of practice.

• Implement skin checks every day for at-risk patients.

• Do not massage bony prominences.

• Keep skin dry and moisturized.

• Redistribute pressure using positioning and support surfaces.

• Develop an individualized turn and positioning program.

• Provide appropriate pressure relieving devices.

• Minimize exposure to moisture.

• Modify, stabilize, or remove risk factors where possible.

• Ensure adequate hydration and nutrition.

• Develop a care plan related to assessment of all risk factors.

• Monitor and revise care plan interventions when necessary.

• Pressure ulcers come from unrelieved pressure. Nothing replaces good practices.

After four years of work, the National Pressure Ulcer Advisory Panel released the New International Guidelines for Pressure Ulcer Prevention and Treatment at its 2009 Biennial Conference. These will be available early this summer, NPUAP expects. Check its Web site at www.npuap.org. Other online resources include:

• A pressure ulcer prevention brochure for patients and their families from Missouri QIO

Primaris at www.primaris.org/documents/resources/pressure_ulcers/resource_materials/patient_education/PUP%20brochure.pdf;

• Pressure ulcer staging guidelines and illustrations of the stages of pressure ulcers from the NPUAP at www.npuap.org;  and

• Discussion on using the Braden scale for predicting pressure ulcer risk at the Hartford Institute for Geriatric Nursing's Web site at http://consultgerirn.org/uploads/File/trythis/issue05.pdf.