Preventing Sacral Pressure Ulcers

Turning and repositioning protocols—combined with the implementation of pressure-reducing and pressure-relieving devices—are crucial to addressing the risk of sacral pressure ulcers.

When implementing protocols, it is important to take into consideration the four main risk factors for sacral pressure ulcers: pressure, friction, shear, and moisture.1 The European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) guidelines recommend that repositioning should be undertaken to reduce the duration and magnitude of pressure over vulnerable areas of the body while avoiding subjecting the skin to pressure and shear forces and using an alternating 30-degree tilted side-lying position.2 The Wound Ostomy and Continence Nurses Society (WOCN) recommends addressing moisture with underpads that are absorbent to wick incontinence moisture away from the skin.3

Another important factor to consider when developing a turning and repositioning protocol is staff safety. Turning and repositioning puts staff at risk for musculoskeletal disorders (MSDs).4 In fact, one survey found that 89% of clinicians said that they or a co-worker have experienced a back, shoulder, or wrist injury due to turning or boosting a patient.5

REFERENCES: 1. Clinical Practice Guidelines: the use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. Royal College of Nursing, Oct 2003. 2. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel, 2009, pp16-18. 3. Wound Ostomy Continence Nurses Society, Guideline for prevention and management of pressure ulcers, 2010, pp14-15, 21. 4. Occupational Safety and Health Administration (OSHA), Guidelines for nursing homes: ergonomics for the prevention of musculoskeletal disorders, 2009. 5. Survey conducted by Sage Products LLC, data on file.

Safe Patient Handling Initiative Results in Reduction in Injuries and Improved Patient Outcomes for Pressure Ulcer Prevention
Heather Way RN, BSN, MSN, Critical Care Clinical Specialist
Presented at the 2014 Safe Patient Handling East Conference on March 27, 2014
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Use of a Repositioning System in Postoperative Cardiovascular ICU Patients Results in a 63% Reduction in Facility-Acquired Sacral Pressure Ulcers
Flockhart L, Fielding C
Presented as the 17th Annual Wound Care Conference November 3-6, 2011
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Combination of Safe Patient Handling and Use of Ergonomic Repositioning Device Reduces Hospital Acquired Pressure Ulcers and Employee Injury Claims
Molly Persby, RN, C, MHSA, Divisional Vice President, Clinical and Quality Services, Select Medical
Poster presented at the ALTHA’s 2012 National Clinical Conference, Dallas TX, May 16-18, 2012
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Save the Butts: Preventing Sacral Pressure Ulcers by Utilizing an Assistive Device to Turn and Reposition Critically Ill Patients
Hall K, DNP, RN, GCNS-BC, CWCN-AP, Clinical Nurse Specialist
Poster presented at the Poster presented at the 25th Annual Symposium on Advanced Wound Care (SAWC); April 19-22, 2012
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