First name: Surname: Company: Date: Pressure Sores Prevention & Awareness Please complete the above, in the blocks provided, as clearly as possible. Completing the details in full will ensure that your certificate bears the correct spelling and date. The date should be the day you finish & must be written in the DD/MM/YYYY format. Copyright Notice This booklet remains the intellectual property of Redcrier Publications L td The material featured in this document is subject to Redcrier Publications L td copyright protection unless otherwise indicated; any breach of this may result in legal action.any other proposed use of Redcrier Publications L td material will be subject to a copyright licence available from Redcrier Publications L td.the information enclosed is not to be used, leased or lent to any one intending to use its contents for training purposes, neither is it to be stored on any retrieval systems for use at a later date. V9.0216.02 Redcrier Publications Limited 2016
Contents Index. Page 2 Learning outcomes. Page 3 Fundamental standards. Pages 3-4 Introduction. Page 5 Unit One. Pages 6-14 Causes and prevention of pressure sores. Unit One Questions. Page 15 Unit Two. Pages 16-20 Recognising pressure sores. Unit Two Questions. Page 21 Unit Three. Pages 22-26 Treatment and complications. Unit Three Questions. Page 27 Unit Four. Pages 28-29 Legislation and documentation. Unit Four Questions. Page 30 Redcrier manuals that support this one. Page 31 N.B: We are aware that official practice is to use the terms service users or people using this service to describe those receiving care. We prefer the term client and use it throughout our training package. Key: worksheet example important 2
Learning outcomes. Recognise a pressure sore. Identify causes of pressure sores. Know how to prevent pressure sores. Identify a person at risk of developing pressure sores. Understand how pressure sores should be treated and recognise complications. Fundamental standards. The fundamental standards are the standards by which CQC will inspect social care. The standards are based on the regulations from the Care Act 2014 and CQC have changed the focus for the purposes of inspection. The fundamental standards are those standards that no care setting must fall below. The standards are based on five areas as follows: Safe. Effective. Caring. Responsive. Well led. People are protected from abuse and avoidable harm. People s care, treatment and support show quality of life and promote good outcomes, and providers should show evidence to prove it. Care should be person centred involving dignity and respect, and compassion. Following correct working procedures as agreed by your workplace and as set out in the client s care plan. Management leadership and governance should ensure all of the above happens. Staff training should be recognised and openness and fairness be apparent. These areas are known as key lines of enquiry or KLOES. Each KLOE has a set of criteria which CQC use to check whether the fundamental standards are being met. 3
The fundamental standards are as follows: Person centred care. Ensuring that those receiving the care are at the centre of all decisions. Dignity and respect. Providing the client with dignity and respect in all aspects of their care. Need for consent. Asking the client s permission before carrying out tasks that affect them. Safe care and Following correct working procedures as agreed by your workplace treatment. and the client s care plan. Safeguarding service Following agreed working and safeguarding procedures and being users from abuse. aware of signs and symptoms. Meeting nutritional Being aware of dietary needs, working with the care plan, ensuring needs. clients have the right equipment and conditions to eat. Cleanliness, safety and suitability of premises and equipment. Receiving and acting on complaints. Good governance. Staffing. Duty of candour. Carrying out required checks of premises and equipment, implementing cleaning rotas and carrying out safety checks. Having a complaints policy and procedure in place that is accessible to all and act in accordance with the policy when dealing with complaints. Ensuring that all aspects of the workplace is overseen and policies and procedures are implemented and monitored regularly. Fit and proper persons employed. Fit and proper person requirement for Directors is followed. Relevant information must be volunteered to all persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made. Our Redcrier manuals will provide your staff with training to support attainment of the fundamental standards. 4
Introduction. Pressure sores, also known as bedsores, pressure ulcers or decubitus ulcers affect areas of the skin and underlying tissue. Throughout this manual we will refer to them as pressure sores rather than using any of the other terms. These sores are caused when the affected area of skin is placed under too much unrelieved pressure. Some parts of the body are more at risk of developing pressure sores than others. Areas most at risk are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair. It is estimated that just under half a million people in the UK will develop at least one pressure sore in any given year. This is usually people with an underlying health condition. For some pressure sores are an inconvenience that require minor care. For others, they can be serious and lead to life threatening complications, such as blood poisoning or gangrene. The cost of treating a pressure sore varies from 1,200 to 15,000. Costs increase with the severity of the sore because of the time required to heal is longer and the incidence of complications is higher in more severe cases. In 2010, more than 27,000 people died with pressure sores or infected wounds, 218 of these recorded pressure sores as the cause of death. As you can see in most cases the pressure sores are not the cause of death but their presence demonstrates that thousands of patients are receiving poor care during the last days and weeks of their lives. In February 2016 a negligent care home director was jailed for corporate manslaughter after one of his residents died. When the client was found she was skeletal, severely dehydrated, lying on a bed soaked in urine and had a large open pressure sore at the base of her back, which was contaminated with faeces. This is the first corporate manslaughter conviction for a care home setting in England. 1 in 20 people who are admitted to hospital with a sudden illness will develop a pressure sore. People over 70 years old are particularly vulnerable to pressure sores as they are more likely to have mobility problems and ageing of the skin. People with dementia are more vulnerable to pressure sores because of associated problems, such as mobility, poor diet and hydration, incontinence, agitation or restlessness causing friction on skin. This manual will outline why it is important that care staff are aware of what they are, how to treat them, and why its important to try and implement procedures that halt any potential development of pressure sores. 5
Unit Two Recognising pressure sores. Within your role in the care sector you are likely to come across pressure sores. Although they can occur in any age group they may be seen more in older people, who are likely to be more prone, due to changes in the skin, less mobility and medical conditions such as incontinence and dementia. As part of the admission procedure for clients in your workplace, they should be assessed for: a. The presence of pressure sores. b. Their potential risk of developing them. The results of this assessment and any procedures identified should then be included in the clients care plan. Parts of the body where pressure sores may occur: Shoulders or shoulder blades. Elbows. Back of your head. Rims of your ears. Knees, ankles, heels or toes. Spine. Tail bone, the small bone at the bottom of your spine. Your buttocks. The back of your arms and legs. The back of your hip bone. From this list we can see that developing a pressure sore could be a real possibility for many of our clients, therefore being able to identify warning signs is important. Changes in skin colour Skin over bony areas (lower back, hips, heels, elbows, etc.) may appear reddened and may turn white when gently pressed with a finger. Skin may also appear bruised, having a blue, purple, or black colour. Changes in temperature When a pressure sore is beginning the skin may feel warm to the touch or in some cases may feel cool surrounding the affected area. 16
The Skin. The skin is the largest organ of the body, with an average total area of about 2M 2, weighing about 5kgs. The skin protects us from infection and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold. Three layers: The epidermis, the outermost layer of skin, provides a waterproof barrier and creates our skin tone. The dermis, beneath the epidermis, contains blood and lymph vessels, tough connective tissue, glands that produce sweat, which helps regulate body temperature, and sebum, an oily substance that helps keep the skin from drying out. The deeper subcutaneous tissue (hypodermis) is made of fat and soft tissue. The skin s colour is created by special cells called melanocytes, which produce the pigment melanin. Melanocytes are located in the epidermis. Changes in the consistency of our skin, particulary the beginning of a pressure sore, may make the affected skin feel firm to the touch or may make it feel as though it s filled with fluid. 17
Changes in sensation pain, tingling, numbness or itching in affected areas may be present. Stages of pressure sores: Stage 1. The skin is usually red or discoloured or may feel hard or warm to touch compared to surrounding areas. When you press on it, it often stays red and does not lighten or turn white like other areas do. The redness or change in colour does not fade within 30 minutes. Stage 2. Epidermis Dermis Bone Soft tissue Subcutaneous fat In this stage the upper layer of skin known as the epidermis is broken, creating a shallow open sore. The second layer of skin known as the dermis may also be broken. Pus or fluid leakage may or may not be present. 18
Stage 3. Stage 4. In this stage the wound reaches the muscle and can go down as far as the bone. Usually dead tissue and pus are present. There is also a high possibility of infection. Exposed bone or muscle is usually visible. The wound extends through the dermis into the fatty subcutaneous tissue. Bone, tendon and muscle are not visible. Look for signs of infection such as redness around the edge of the sore, discoloured pus, smell or fever. When a person has been identified as at risk of developing a pressure sore, or has already developed a pressure sore, it may be helpful to use a system which encourages staff to easily identify who is at risk. 19
Some ideas may be: Visual cues at bed area. Visual cues on clients door or name board. Sharing information in staff handover books or sheets. Sharing information at staff briefings etc. Using a system that is easily recognisable will help you to focus on which clients need pressure sore care. It is a good idea if staff and the clients are involved in the development of such a system so that it is recognisable by all. 20
Unit Two Questions 1. When a client is admitted to your workplace what should they be assessed for regarding bed sores? 2. 3. 4. 5. 1. 2. 1. 2. Name two parts of the body where pressure sores may occur. Name two changes that identify a pressure sore developing. What does the skin protect us from? How would you recognise a stage one pressure sore? 21