Preventing pressure injuries in long-term care
Skin is the largest organ of our body. It helps protect our body from the environment and regulates our temperature. Skin detects temperature, touch and vibration. It hosts blood vessels, nerves. It protects us from infections by being our first line of defence. Age, medications and certain health issues can contribute to weakening the skin.
What is a pressure injury?
A pressure injury is damage to the skin and/or tissue below the skin.
Pressure injuries often from near or on bony parts such as head, ears, shoulder blades, elbows, tail bone and buttocks.
What causes pressure injuries?
Pressure injuries can happen if:
- The resident stays in one position for too long (pressure)
- The resident's skin rubs against something (e.g. bed sheets) too much (friction)
- The resident slides or shifts in their bed or chair (shearing)
- The resident's skin is exposed to sweat, urine or stool for a long time (maceration)
Some pressure injuries start from the skin and may deepen. Others start close to the bone and as they progress, open toward the skin.
Sometimes, the care team cannot see the problem until the pressure injury is very serious. That is one reason why prevention and monitoring is so important.
Pressure injuries are deadly serious!
- Cause extreme pain
- Allow infections to enter the body
- Become large, open sore which may be difficult to heal
- Lead to other health problems, even death
Our interprofessional team works together to prevent pressure injuries. We follow best practice guidelines set by the Registered Nurses' Association of Ontario as established in their long-term care best practices program Risk Assessment and Prevention of Pressure Injuries.
Preventing pressure injuries can be integrated into the residents' daily routine. Strategies include:
- Moving (repositioning at least every two hours) and shifting positions;
- Drinking and eating a nutritious and well-balanced diet to maintain healthy skin;
- Keep skin clean (changing incontinence products regularly, as needed);
- Observing and reporting changes in skin condition
In some cases, other strategies may be used, such as using an alternating air mattress or repositioning schedule, keeping the head of the bed as low as possible when the resident is sleeping, using a moisturizer.
Our interprofessional team assesses all residents regularly for risk of pressure injuries.
Any changes or concerns with the integrity of the skin should be communicated to the nurse, when discovered. This includes:
- Reddened area that does not turn pale after pressing firmly
- Blisters, red or darkened areas anywhere on the skin;
- Opened or blackened area(s) on the skin.