Prevalence of pressure damage in hospital patients in the UK

Establishing an Appropriate Pressure for the Transparent Disc Method to Distinguish Early Pressure Injury and Blanchable Erythema

Background: Non-blanchable erythema is used as a diagnostic indicator for stage 1 pressure injury (early PI); it is distinguished from blanchable erythema (BE) by the application of “light pressing”. Considering the low of the accuracy of the degree of pressure applied, it is difficult to use this method in clinical settings. Methods: We constructed models of BE and early PI in order to determine the most appropriate pressure values using the transparent disc method. We observed erythema by using a Dermo-camera to quantify the gray and a* values of the wound area along with a spectrophotometer. Results: BE started to fade at 50 mmHg, while the gray values became statistically significant when the pressure was increased to 100 mmHg (p < 0.05). However, erythema remained even when the pressure was increased to 150 mmHg soon after decompression. By contrast, the early PI was showed to be non-blanchable for the longest time under a pressure of 150 mmHg, but by 18 h it had decreased and the erythema faded more obviously after applying pressure. Conclusions: We proposed that a pressure of 50−100 mmHg was more appropriate for light pressure, but this may vary when different instruments are used. Variations may occur in either BE or early PI, therefore, careful attention should be paid during observations.

Low serum albumin level as an independent risk factor for the onset of pressure ulcers in intensive care unit patients

Critically ill patients are at high risk of developing pressure ulcers (PUs) and patients who develop PUs remain significantly longer in the intensive care unit (ICU) with significantly increased morbidity and mortality. Therefore, the identification of patients at truly increased risk is important. The aim of this study was to examine the association of low serum albumin present at admission in ICU patients with the onset of PUs. We conducted a retrospective cohort study on 610 patients who were admitted to intensive care unit. Level of serum albumin and other biochemical indices, recorded at the time of admission, were collected. We collected information about PU occurrence after admission and conducted a statistical analysis with biomarkers at ICU admission and during hospital stay. The incidence of PU in the ICUs was 31% and about 70% of patients with PUs had hypoalbuminemia at admission. The lowest values of serum albumin in patients with PUs were directly proportional to the severity of ulcers. In this study, we found a close association between serum albumin and PUs. In fact serum albumin was negatively correlated with PU and may be considered one of the independent determinants of PU occurrence in patients admitted to ICUs.

On the potential of ultrasound elastography for pressure ulcer early detection

PURPOSE

Pressure ulcers are areas of soft tissue breakdown induced by a sustained mechanical stress that damages the skin and underlying tissues. They represent a considerable burden to the society in terms of health care and cost. Yet, techniques for prevention and detection of pressure ulcers still remain very limited. In this article, the authors investigated the potential of ultrasound elastography for pressure ulcer early detection. Elastography is an imaging technique providing local information on biological tissue mechanical properties. It is relevant for pressure ulcer detection as this pathology is associated with a gradual stiffening of damaged tissues, beginning in the deeper tissues and progressing toward the skin surface.

METHODS

A 2D ultrasound elastography method was proposed and its ability in terms of pressure ulcer detection was validated through numerical simulations and physical acquisitions on pressure ulcer mimicking phantoms. In vivo experiments on a rat model are also reported. A maintained pressure was applied on the animal thigh, with a view to generate a pressure ulcer, and ultrasound data were acquired and processed before and after application of this pressure.

RESULTS

Numerical simulations demonstrated that a pressure ulcer can theoretically be detected at a very early stage with ultrasound elastography. Even when the ulcer region was characterized by a low stiffening (ratio of 1.8 relative to normal tissues), the corresponding elastogram clearly underlined the pathological area. This observation was confirmed by the results obtained on a physical phantom mimicking a pressure ulcer at an early stage. Computed elastograms showed strain differences between areas mimicking healthy and pathological tissues. Results corresponding to in vivo experiments revealed a difference in the way tissues behaved before and after the pressure was applied on the animal thigh, which strongly suggests the presence of a pathological area.

CONCLUSIONS

Experiments demonstrated that ultrasound elastography is a promising technique for pressure ulcer detection, especially at an early stage of the pathology, when the disease is still visually undetectable. In the absence of any gold standard method, this is also a first step toward the development of a quantitative technique.

ROHO Dry floatation technology: implications for clinical practice

This article discusses the aetiology of pressure ulcers, the clinical and financial cost of pressure ulcer prevention and the need for pressure reducing equipment. The role of Dry floatation in pressure ulcer prevention and management is explored. How Dry floatation technology works is discussed and its use within clinical practice is highlighted. The evidence to support Dry floatation is presented.

EPUAP pressure ulcer prevalence survey in Sweden: a two-year follow-up of quality indicators

OBJECTIVE

The aim of this study was to determine the effects of quality improvement programs for pressure ulcer prevention by conducting a follow-up survey in a hospital in Sweden.

DESIGN

A cross-sectional survey design with comparison between data collected in 2002 and 2004.

SETTING AND SUBJECTS

All inpatient areas were surveyed in the surgical, medical, and geriatric departments in a university hospital. A total of 369 patients were included.

INSTRUMENTS

The European Pressure Ulcer Advisory Panel data collection form including some additional questions.

METHODS

The 1-day survey was conducted on March 23, 2004. Each patient was visited by 2 registered nurses, who inspected the patient's skin for any pressure ulcer classified according to the EPUAP grading system.

RESULTS

There were no significant differences in gender, age, or Braden score between the patients in surgical, medical, or geriatric care in 2002 and 2004. The overall prevalence of pressure ulcers was 33.3% (grade 1 excluded: 10.9%) in 2002 and 28.2% (grade 1 excluded: 14.1%) in 2004. In surgical care, the prevalence was reduced from 26.8% to 17.3% (P = .051). In medical care, the prevalence was 23.6% in 2002 and 26.7% in 2004. Corresponding prevalence figures for geriatric care were 59.3% and 50.0%. A quarter of the patients in surgical care, a third in medical care, and more than half in geriatric care had a pressure ulcer upon arrival at the ward. The use of pressure-reducing mattresses had increased significantly from 16.0% to 42.7% in medical care (P = .000).

CONCLUSIONS

The EPUAP methodology has facilitated the introduction of pressure ulcer as a quality indicator at hospital level. Pressure ulcer prevalence surveys with a standardized methodology should be repeated on a regular basis in order to stimulate quality improvement.

Is the distinction between superficial pressure ulcers and moisture lesions justifiable? A clinical-pathologic study

OBJECTIVE

Pressure ulcers are classified into 4 distinct stages, which allows comparisons between institutions and even countries. Recently, attempts have been made to single out so-called moisture lesions from the early stages of pressure ulcer lesions as a distinct entity.

METHODS

To investigate the justification for this development, 14 histopathologic samples from patients with both incontinence and pressure ulcer lesions were studied in an attempt to delineate differences in the pathophysiology and histopathology.

RESULTS

Two distinct histopathologic pictures emerged: an ischemic pattern and a pattern of irritation. The latter appeared to be associated with lesions that clinically fit the description of moisture lesions, but this association was not absolute.

CONCLUSIONS

There is no justification for singling out moisture lesions from pressure ulcer lesions. The distinction may even be dangerous when proper preventive measures for the development of pressure ulcers are not taken because of the existence of a possible moisture lesion.

NICE pressure ulcer guideline: summary and implications for practice

This article outlines the principle areas for consideration form the NICE (2005) guideline for pressure ulcer prevention and treatment. All key areas are included and recommendations made for their implementation into clinical practice. A conclusion is made that pressure ulcer prevention is a key indicator of quality care and that all professionals have a responsibility for its implementation.

Cost-effectiveness of pressure-relieving devices for the prevention and treatment of pressure ulcers

Objectives:The cost-effectiveness of alternating pressure-relieving devices, mattress replacements, and mattress overlays compared with a standard hospital (high-specification foam mattress) for the prevention and treatment of pressure ulcers in hospital patients in the United Kingdom was investigated.

Methods:A decision-analytic model was constructed to evaluate different strategies to prevent or treat pressure ulcers. Three scenarios were evaluated: the prevention of pressure ulcers, the treatment of superficial ulcers, and the treatment of severe ulcers. Epidemiological and effectiveness data were obtained from the clinical literature. Expert opinion using a rating scale technique was used to obtain quality of life data. Costs of the devices were obtained from manufacturers, whereas costs of treatment were obtained from the literature. Uncertainty was explored through probabilistic sensitivity analysis.

Results:Using £30,000/QALY (quality-adjusted life year) as the decision-maker's cut off point (the current UK standard), in scenario 1 (prevention), the cost-effective strategy was the mattress overlay at 1, 4, and 12 weeks. In scenarios 2 and 3, the cost-effective strategy was the mattress replacement at 1, 4, and 12 weeks. Standard care was a dominated intervention in all scenarios for values of the decision-maker's ceiling ratio ranging from £5,000 to £100,000/QALY. However, the probabilistic sensitivity analysis results reflected the high uncertainty surrounding the choice of devices.

Conclusions:Current information suggests that alternating pressure mattress overlays may be cost-effective for the prevention of pressure ulcers, whereas alternating pressure mattress replacements appears to be cost-effective for the treatment of superficial and severe pressure ulcers.

Accuracy and Quality in the Nursing Documentation of Pressure Ulcers

OBJECTIVE

To determine the accuracy and describe the quality of nursing documentation of pressure ulcers in a hospital care setting.

DESIGN

A cross-sectional survey was used comparing retrospective audits of nursing documentation of pressure ulcers to previous physical examinations of patients.

SETTING AND SUBJECTS

All inpatient records (n = 413) from February 5, 2002, at the surgical/orthopedic (n = 144), medical (n = 182), and geriatric (n = 87) departments of one Swedish University hospital.

INSTRUMENTS

The European Pressure Ulcer Advisory Panel data collection form and the Comprehensiveness In Nursing Documentation.

METHODS

All 413 records were reviewed for presence of notes on pressure ulcers; the findings were compared with the previous examination of patients' skin condition. Records with notes on pressure ulcers (n = 59) were audited using the European Pressure Ulcer Advisory Panel and Comprehensiveness In Nursing Documentation instruments.

RESULTS

The overall prevalence of pressure ulcers obtained by audit of patient records was 14.3% compared to 33.3% when the patients' skin was examined. The lack of accuracy was most evident in the documentation of grade 1 pressure ulcers. The quality of the nursing documentation of pressure ulcer (n = 59) was generally poor.

CONCLUSIONS

Patient records did not present valid and reliable data about pressure ulcers. There is a need for guidelines to support the care planning process and facilitate the use of research-based knowledge in clinical practice. More attention must be focused on the quality of clinical data to make proper use of electronic patient records in the future.

Controversies in classifying and assessing grade I pressure ulcers

There is more uncertainty on how to define a grade I pressure ulcer than any other type. The confusion will need to be dispelled and a consensus reached if a national grading system is to be implemented. This review explores the options.

Incidence and prevalence data: can we ensure greater accuracy?

Practitioners in the UK will only know if they are meeting targets on pressure ulcer reduction if they provide valid and reliable prevalence and incidence data. But all too often, published data contain inconsistencies and can be misleading.

An exploration of the occurrence of pressure ulcers in a British spinal injuries unit

Spinal cord injury (SCI) is associated with increased risk of pressure ulcers, but there are few published data about this in the United Kingdom (UK). This article represents a quantitative exploration of the occurrence of pressure ulcers in a UK spinal injuries unit (SIU). The technique used is a retrospective review of records: details of 144 completed first admissions for SCI between 1998 and 2000 were entered on to a database (SPSS) for analysis. Thirty-two per cent of patients already had pressure ulcers on admission to the SIU, while a total of 56% experienced an ulcer at some stage between injury and discharge from the SIU. Four pressure ulcer risk assessment scales were used (Waterlow, Braden, Norton and SCIPUS-A). These appeared to have moderate predictive power in this population. Pressure ulcers were found to be associated with increased length of hospital stay, density of lesion, surgical stabilization of neck injury before transfer to the SIU, tracheostomy on admission to the SIU and delayed transfer to the SIU after injury. Implications for practice are discussed.

An audit of pressure ulcer incidence in a palliative care setting

This article reports a continuous audit of pressure ulcer incidence within a specialist palliative care unit over 2 years. Details of every patient admission were considered (542 patients). Of these, 26.1% were admitted with pressure ulcers while 12.0% developed pressure damage during their stay. The retrospective audit looked at the ulcers developing in the unit and found these patients were older, stayed 12 days longer and more of them died than the average for all patients admitted to the unit. In total, 95.3% were accurately assessed at 'high' or 'very high' risk using the Waterlow (1985) Pressure Sore Risk Assessment Tool and 89.2% of ulcers were Grade 1 or 2 measured using the Stirling Pressure Sore Severity Scale (Reid and Morrison, 1994). Of all developing ulcers, 78.4% were sacral and the position of the tumour, as well as comfort and positioning difficulties were considered most often responsible. Despite this knowledge and many 'improvements' introduced, the incidence did not improve with superficial ulcers often developing in the last days of life.

Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish elderly population

OBJECTIVE

We investigated the prevalence and associated risk factors of decubitus ulcer in an institutionalized Spanish elderly population.

METHODS

A 1 d cross-sectional study in 50 Spanish geriatric facilities was carried out. Data collection included age, sex, body mass index, presence of decubitus ulcer, duration of ulcer, days of hospitalization, risk according to the Norton scale, associated risk factors, and nutrition status evaluation including assessment according to the Nutrition Screening Initiative. Logistic regression analysis calculated prevalence and association with risk factors.

RESULTS

Data from 827 elderly people (71.3% female) were collected. Mean age (+/- standard deviation) was 82.4 (+/-8.0) y. Decubitus ulcer prevalence was 35.7%, with no sex differences (34.1% males and 37.2% females). Body mass index was inversely associated with ulcer prevalence in a statistically significant way (odds ratio = 0.94, 95% confidence interval = 0.92-0.97), but the following were risk factors: age (1.03, 1.01-1.06), previous ulcer (3.09, 2.16-4.04), diabetes (1.54, 1.02-2.51), functionality (2.91, 2.05-4.12), immobility (8.30, 5.09-11.51), erythema (12.12, 7.46-16.78), dehydration (2.09, 1.31-2.87), and edema (2.35, 1.64-3.06). Subjective evaluation of nutrition status and nutrition status as assessed by the Nutrition Screening Initiative Determine scale (modified) showed a significant linear association with ulcer (P < 0.001), and a score above 14 points in the modified Norton scale was associated with a lower ulcer rate (P < 0.001).

CONCLUSIONS

Prevalence of decubitus ulcer in the Spanish elderly population increased with age, poor nutrition status, immobilization, and impaired functionality.

Prevalence, prevention, and treatment of pressure ulcers: descriptive study in 89 institutions in the Netherlands

The purpose of the present study was to assess the prevalence of pressure ulcers and the use of Dutch guidelines for the prevention and treatment of pressure ulcers. A survey of 16,344 patients in 89 health care institutions on 1 day showed a mean prevalence of pressure ulcers of 23.1%. It was found that Dutch guidelines on some aspects of prevention and treatment of pressure ulcers were not being followed. Only 53% of the patients who should have been positioned on a support surface were positioned on such a device. Fewer than one-third of the patients who should have been repositioned, should have received nutritional support, or should have been educated received these interventions, and only 33.6% of all pressure ulcers were dressed as recommended. More attention to the dissemination and implementation of the guidelines is needed to reduce this high prevalence of pressure ulcers.

Case-mix adjusted incidence of pressure ulcers in acute medical and surgical wards

Pressure ulcers cause considerable pain and suffering and are also a very expensive drain on NHS funding. Measuring prevalence is particularly useful for guiding use of resources whereas incidence is an outcome indicator of quality of care. Patients and illnesses vary and it may be misleading to make assumptions based on crude incidence figures. A system of case-mix adjustment has been developed in Glasgow (GPSISS). This study used GPSISS to measure case-mix adjusted incidence of pressure ulcers in over 15,000 acute hospital patients. The incidence of pressure ulcers ranged from 1.1% to 2.7%. These low rates, and the time cost and effort involved in ensuring quality data, suggests that significant differences in quality of care may be demonstrated more quickly using processes rather than outcomes and may more directly identify where changes in practice are required.

Treatment of a heel blister caused by pressure and friction

The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate. It is important to highlight that during the literature search very little research was found to exist on blister care and it became clear that further research into the nursing care of a blister caused by pressure would be useful to aid nursing care and patient comfort.

UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare?

Although prevalence and incidence figures for pressure ulcers vary widely across health-care settings, common trends can be identified. This review examines data from three countries.

How effective are prevention strategies in reducing the prevalence of pressure ulcers?

The prevalence of pressure ulcers has remained constant at about 7% over the past 20 years, even though considerable time and money has been invested in various prevention strategies. This literature review explores whether pressure-prevention programmes can reduce the prevalence rate still lower or whether they are working but are limited by an increasingly aged population and rising patient acuity.

Pressure sores in children--the acute hospital perspective

There is very little published literature on pressure sores in children and most of the existing literature is qualitative. Using literature from paediatric and adult studies, a schedule was designed to collect quantitative data on aspects that may predispose children to pressure injury. The schedule was piloted in an incidence and a prevalence study at the Royal Liverpool Children's NHS Trust. The sample size was 82 children for the incidence study and 183 children for the prevalence study. Six children in the incidence study and 12 children in the prevalence study sustained pressure injury. Data indicated that factors most strongly associated with pressure injury were nutritional status, mobility and consciousness level. Other factors that were implicated in increasing susceptibility to pressure injury were skin condition, body weight, haemodynamic status and hydration. Infants and young children most frequently sustained pressure injury on the occipital scalp area and heels. Although this was a small study, it produced some useful preliminary data, and was a valuable exercise to develop a tool for data collection on a larger scale.

Review of interface pressure measurement to establish a protocol for their use in the assessment of patient support surfaces

The interface pressure (IP) between a body and support surface is one objective measure used in the evaluation of the wide variety of pressure relieving equipment that exists for the prevention and treatment of pressure sores. We present a review of the literature associated with making these measurements and discuss the acute need to be able to use them to choose the most effective 'anti-pressure sore devices' for patient care, as well as discussing the difficulties associated with this decision making. We focus on interface pressure monitors describing their development and discussing the questions that remain about the accuracy and relevance of their measurements. An outline of the strengths and limitations of the most commonly used pressure sensors is given. There remains a gap in research in this area that is clinically specific and the need to be able to assess these anti-pressure sore devices with patients in a hospital environment is highlighted. The variants involved in assessing patients on various mattresses and the difficulties associated with this are described. A protocol is suggested in an attempt to improve the use of such devices and establish a better method for quantifying the clinical effectiveness of different support surfaces.

Pressure sore risk assessment in palliative care

Pressure sore prevention in palliative care is recognized as being an essential element of holistic care, with the primary goal of promoting quality of life for patient and family. Little is known about the incidence of pressure sore development and the use of pressure sore risk assessment tools in palliative care settings. The development of a risk assessment tool specifically for palliative care patients in a 41-bedded specialist palliative care unit is described. The risk assessment tool was developed as part of a tissue viability practice development initiative. The approach adopted in the validation of the Hunters Hill Marie Curie Centre pressure sore risk assessment tool was the comparative analysis of professional judgment of experienced palliative care nurses with the numerical scores achieved during the assessment of risk on 291 patients (529 risk assessment events). This comparative analysis identified the threshold for different degrees of risk for the patient group involved: low risk, medium risk, high risk and very high risk. Further work is being undertaken to evaluate the inter-rater reliability of the new tool. A number of issues are explored in this paper in relation to pressure sore prevention in palliative care: the role of risk assessment tools, the sometimes conflicting aims of trying to ensure comfort and prevent pressure sore damage, and the uncertainties faced by palliative care nurses when they are trying to maintain quality of life for the dying.

Efficacy and cost-effectiveness of the Thermo contour mattress

Use of air mattresses in reduction of pressure sore incidence is an important part of quality patient care. However, there will never be enough air mattresses to match the demand as increased education and an increase in the general provision of air mattresses can lead to an unrealistic expectation of obtaining air mattresses when required for patients. This raises the demand for air mattresses and increases costs within hospital trusts. This study examined a way to redress the balance through use of an alternative, cost-effective type of mattress (thermoelastic polymer) in the prevention of pressure sores. Prime consideration was given to the comfort of the patient. The claims of the manufacturers, Barrington Healthcare, that 'patients with Waterlow scores of 23 can be nursed safely on this product' were explored as part of the study. A total of 407 patients took part over a 6-month period. Twenty-four Thermo contour mattresses were loaned to one ward for the study and patients were allocated to the mattress through admission to the experimental ward. Patients were then split into two groups on two wards. Group B were allocated to a Thermo contour mattress and group A were nursed on air mattresses and foam mattresses generally used throughout the trust. Results showed that more patients were comfortable on the Thermo contour mattresses than on all other mattresses. Patients with Waterlow scores under 25 did not develop pressure sores on the Thermo contour mattress. However, the sample of patients with a Waterlow score of between 20 and 25 was small and therefore further research is required.

The prevalence of pressure damage in acute care hospital patients in the UK

This paper aims to provide information on the prevalence of pressure damage in UK hospital patients since 1992. A survey method and data handling service provided by a medical device company was used to set targets and monitor trends. The results of these surveys provide evidence that over a six year period, the prevalence of pressure damage in this population in the UK has shown a significant reduction.

Nursing aspects of pressure sore prevention and therapy

Pressure sores remain a significant problem in hospitals and domestic settings, affecting people of all ages, social class and race. Associated complications may be life threatening, e.g. sepsis and osteomyelitis. Other less dangerous, but nevertheless compromising outcomes such as pain, discomfort and low self-esteem and body image can cause personal suffering, and may add extra demand for limited resources. The exact state of pressure sore occurrence remains difficult to determine, particularly in the community. Recent trends in pressure area management present a multidisciplinary approach, eroding traditional perceptions of pressure sores as a solely nursing problem. Written from nursing perspective, this article summarizes principles of good practice relating to pressure sore prevention and therapy, emphasizing the importance of documenting observed events, rather than assumptions or opinions, and the need for healthcare professionals to approach problems and needs from a collaborative stance. Pressure sore risk assessment and classification are discussed, and an overview of nutrition, moving a handling, selecting support surfaces, principles of wound management, and skin care are considered.

Evaluation of pressure-redistributing replacement mattresses

This study examined four types of foam replacement hospital mattresses after three and a half years of general use in orthopaedic trauma and spinal surgery wards. Ten were examined to ascertain the condition of the cover and the foam in order to add to the body of knowledge about the life span of these mattresses. Only one mattress was in good condition; five were condemned at the time of inspection and four were recommended for early review because they showed signs of deterioration. It is clear that more objective evidence regarding the life span of hospital mattresses is required to assist with purchase decision-making.

Optical assessment of recovery of tissue blood supply after removal of externally applied pressure

The authors use photoelectric plethysmography to determine the external occlusion pressure for blood vessels in human tissue in vivo. Three wavelengths are employed; 950 nm (infra-red), 640 nm (red) and 583 nm (yellow). Each probe is applied in turn to one finger of each subject. Pressure is applied, using a neonatal blood pressure cuff, to the finger via the probe. This pressure is increased linearly to 20 kPa (150 mmHg) over 15 s and then decreased linearly to zero over 15 s. The pressure at which perfusion returns is obtained for four repeat measurements at each wavelength. The mean (+/-standard deviation) occlusion pressures for all 13 subjects investigated are 7.1 (+/-1.9) kPa for infra-red, 6.3 (+/-1.7) kPa for red and 5.8 (+/-1.8) kPa for yellow. The pressure is 0.79 (+/-0.83) kPa lower for red compared with infra-red (P < 0.01), 0.54 (+/-0.60) kPa lower for yellow compared with red (P < 0.002) and 1.3 (+/-1.0) kPa lower for yellow compared with infra-red (P < 0.005). The reduced penetration of shorter optical wavelengths can be used to detect the lower occlusion pressures of the smaller blood vessels nearer the skin surface.

Pressure sore risk calculators: some methodological issues

Pressure sore risk calculators have assumed a cardinal role in pressure sore prevention and management. Doubts have been expressed as to the extent to which the use of risk calculators should direct care as they have not been found to display high levels of reliability and validity. This paper raises important methodological issues regarding the reliability and validity of risk calculators in order to inform the debate as to the direction of future research in this area.

Types of pressure-relieving equipment available: 1

This is the first of two articles which consider the practical difficulties in selecting pressure-relieving devices for patients. The selection of pressure-relieving equipment has become increasingly difficult as the number of commercially available products rises. This article reviews the modes of action of the equipment, including alternating pressure and constant low pressure, outlining the differences between individual pieces of equipment. It will also include a brief summary of the factors which are important to acknowledge when selecting seating.

The formation of pressure sores and the role of nursing care

A discussion of past and present literature examines factors which lead to the formation of pressure sores and looks at attitudes towards the role of nursing care

A review of pressure damage prevention strategies

The prevention of pressure damage is a fundamental aspect of nursing care. Despite this and the amount of literature available, the prevalence and incidence of pressure sores do not appear to be diminishing. This review focuses on elements of care that are within the power of nurses to attain and suggests strategies for promoting quality care by simple, economic and effective means.

Collaboration through project management

This paper focuses on project management and examines its value for nurse managers. The paper explores the implementation of project management and its contribution to the collaboration between two Trusts in West Suffolk, UK. It argues that project management could serve the interest of nurse managers within the changing culture of the health service. The collaborative project was funded by the East Anglian Regional Audit Team.

The fluidised bed

The process of fluidisation involves blowing warm air through small solid microspheres thus creating a liquid, without wetness. The warmth provides some important properties including reducing the metabolic rate in thermal injury which has a beneficial effect on mortality, modifying catabolism after surgery, providing gradual vasodilation in shock and core temperature stability in illness. The fluidisation ensures prevention and successful treatment of pressure sores, a comfortable and less stressful environment than conventional care, a reduction in pain, ease of wound care, discourages a bacterial persistence and reduces the work of the nurse. The importance of proper fluid balance, bacteriological care and limitations of posture must be appreciated in using the bed.

Pressure sores--a ticking time-bomb

Health Service managers and administrators increasingly find themselves under fire for intruding on what have traditionally been regarded as clinical or nursing decisions as demands increase for more efficiency and cost cutting, particularly in hospital care. Now there is a new turn of the screw. It appears that pressures sores, frequently given low priority despite being potential killer, are revealed to be a time-bomb ticking away under the bedclothes. Indeed, the estimated 2000 deaths a year in the UK attributed to pressure sores suggest that conventional hospital beds and mattresses should carry a health warning!

Wound care in an ageing population

An examination of the implications for wound care of demographic projections showing a significant growth in the older population over the next 40 years.