Nowadays, pressure ulcers (PU) turn out to be a frequent problem for many people of different ages. Some hospitals develop their guidelines and protocols to avoid PU complications. Some healthcare facilities are still in need of effective programs and improvements. In this paper, special attention to care that can be offered to the patients at high risk for developing a pressure ulcer will be paid to investigate the effectiveness of emergency department protocols and usual care in terms of possible hospitalization.
Definition
A pressure ulcer is a condition when the person’s skin and underlying tissue get worsened and damaged because of unrelieved pressure. This type of injury is usually caused by physiologic events and inappropriate external environments that lead to tissue ischemia (Cano et al., 2015). Ulcers are formed when a person cannot move or has to lie much time because of certain physical problems, diseases, or other health conditions.
Epidemiology
Pressure ulcers are usually observed among people who have reduced sensitivity to pain, suffer from poor blood circulation, or are immobile. Today, more than 2.5 million Americans suffer from this disease with about 30% occur in hospitals (Boyko, Longaker, & Yang, 2018). Therefore, hospitals and special care facilities aim at developing new treatment plans and preventive methods to deal with PU. This type of ulcer may be hospital-acquired or developed at home. Still, hospitalization is the common outcome that has to be avoided among patients of different age groups.
Clinical Presentation
The peculiar feature of the clinical presentation of pressure ulcers is that not all people can recognize it at an early stage. Human skin, muscles, and soft tissues may resist pressure in different ways. Therefore, some patients and even doctors cannot recognize this condition until the skin damage is evident (Boyko et al., 2018). It is recommended to begin the assessment from the bony prominence where pressure can be combined with other problems and cause certain skin damage. PU should not be confused with burns, dermatitis, and excoriations.
Complications
Sepsis remains one of the most frequent and dangerous complications of pressure ulcers. However, patients who are at high risk of having PU should also be careful with such complications as infections and osteomyelitis. Though the mortality rate is not high, it should not be disregarded in clinical guidelines. Patients have to be informed about all possible outcomes of inappropriate or delayed treatments.
Diagnosis
The diagnosis of pressure ulcers is not complex and usually depends on the professionalism of a doctor. A thorough skin examination is the first step that cannot be ignored. The stage of wounds may vary among patients, and as soon as the stage of damage is defined, a treatment plan can be offered. In addition to the physical exam, a doctor may ask several questions to clarify the period of the damage, the reasons for this condition being developed, and the steps taken to prevent complications. The information about recent life changes and new requirements can help to approve or disprove the diagnosis.
Conclusion with PICOT Question
In general, pressure ulcers introduce a problem that can be solved and even prevented in case patients follow simple hygiene rules and standards. Doctors pay special attention to the patients who may be at high risk for developing pressure ulcers. However, sometimes, the condition of the patient is hard to evaluate from first sight. Therefore, it is recommended to develop special protocols at emergency departments and while providing usual care.
Regarding research and conclusions made, the following PICOT question can be asked by a researcher: “In patients who are identified as high risk for developing a pressure ulcer (P), does the implementation of a pressure ulcer protocol initiated in the emergency department (I) as compared to patients who receive usual care (C), reduce the incidence of hospital-acquired pressure ulcers (O) on day 3 of hospitalization (T)?
References
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57-67.
Cano, A., Anglade, D., Stamp, H., Joaquin, F., Lopez, J. A., Lupe, L., … Young, D. L. (2015). Improving outcomes by implementing a pressure ulcer prevention program (PUPP): Going beyond the basics. Healthcare, 3(3), 574-585.