• Identify the first step in planning for pressure ulcer prevention.
• Recognize pressure ulcer stages using the National Pressure Ulcer Advisory Panel classification system.
• Identify strategies used in the prevention of pressure ulcers.
• Recognize appropriate treatment for pressure ulcers based on current standards of care.

Angela R. Curtis, PhD
Managing Editor
Assistant Professor, Geriatric Education Manager
Division of Gerontology, Geriatrics and Palliative Care
University of Alabama at Birmingham

Richard Allman, MD
Parrish Endowed Professor of Medicine and Director
Birmingham/Atlanta VA GRECC
Center for Againg and the Division of Gerontology, Geriatrics and Palliative Care
University of Alabama at Birmingham

Carol Hill, RN, BSN, RAC-CT
Program Manager - Long Term Care
AQAF

Birmingham, Alabama

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.

Dosages, indications, and methods of use of any drug referred to in this publication may reflect the clinical experience of the authors, clinical literature, or other clinical resources. Therefore, please see the full prescribing information before using any product mentioned. UAB is an equal opportunity/affirmative action institution.

This material was prepared in conjunction with AQAF, the Medicare Quality Improvement Organization for Alabama, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy, 8SOW-AL-NHQI-07-44.

Pressure ulcers, also know as bedsores, decubitus or pressure sores, consist of localized injury to the skin and/or underlying tissue. Usually over a bony prominence, pressure ulcers can result from pressure or a combination of pressure with shearing and/or friction.[1] Rates for pressure ulcer development vary from 0.4% to 38% in acute care, to 2.2% to 23.9% in long-term care, and 0% to 17% in home care.[2]

The development of pressure ulcers can result in prolonged recovery time, pain, increased cost, infection and even death. In the United States, it is estimated that the cost to heal a pressure ulcer can range from $500 to $40,000. [3]

According to the Wound Ostomy and Continence Nurses Society, the overall management goals for pressure ulcers are: [4]

• Identification of individuals at risk for development of pressure ulcers and initiation of early prevention programs
• Implementation of appropriate strategies/plans to:
  • Attain/maintain intact skin
  • Prevent complications
  • Promptly identify and manage complications
  • Involve patient and caregiver in self-management
• Implementation of cost-effective strategies/plans that prevent and treat pressure ulcers

A 65-year-old woman is admitted to the hospital with a left-brain stroke resulting in right hemiparesis and aphasis. She is confined to bed or chair, and requires some assistance with repositioning in the bed. She is unable to shift points of pressure over bony prominence when sitting. She is incontinent of urine and stool, but is able to follow some instructions. On physical examination, her blood pressure is 192/102, pulse 68, and temperature is 37.2 degrees C. Her weight is 52 kg. She is alert. Nonblanchable erythema of the skin over the sacrococcygeal bone is noted. She has mild difficulty chewing and swallowing food. Laboratory studies include: CBC with hemoglobin 13.2; WBC 7,500 (65% polymorphonuclear cells, 32% lymphocytes, and 3% monocytes).