1. Stotts, Nancy A. EdD, RN, FAAN
  2. Gunningberg, Lena PhD, RN

Article Content

A review of guidelines.


Anumber of prevention guidelines exist for planning care for people who are at risk for pressure ulcers.1-5 To identify the major themes in preventive care, we reviewed guidelines established by the University of Iowa; the Registered Nurses' Association of Ontario; the Wound, Ostomy, and Continence Nurses Society; and the Institute for Healthcare Improvement (IHI). Each of the following recommendations appeared in at least two of these guidelines.


Pressure Relief


* Reposition patients who aren't using pressure-relieving devices every two hours.1, 4, 5 Those using pressurerelieving devices should be repositioned every two to four hours.2


* Implement a positioning schedule.1, 4


* Use pillows or foam to prevent surfaces from coming into contact with bony prominences.1,4


* Keep the head of the bed elevated to 30[degrees] or less2, 4, 5 and position the patient on her or his side at a 30[degrees] angle from supine.4, 5


* Avoid massaging bony prominences.2, 4, 5


* Those who are confined to a wheelchair and can reposition themselves should do so every 15 minutes,2,5 or the provider should change the patient's position every hour.2, 4


* Don't use ring devices.2,4, 5


* Relieve pressure on heels.1, 2, 4


* Use a turn or lift sheet to turn or transfer the patient.2, 4, 5


* Ensure that chairbound patients maintain proper spinal alignment.2, 4


Pressure-Relieving Surface


* Place a pressure-relieving surface on beds and chairs.1, 2, 4, 5


* Use pressure-relieving devices in the operating room.1, 2, 4



Skin Moisture


* Keep the skin dry and well lubricated.1,4, 5


* Cleanse the skin when the patient is incontinent.1, 2, 4


* Use moisture barriers.1,2


* Establish bowel and bladder programs for continence.2, 4


* Use skin barriers with incontinent patients.1, 2, 4Other


* Educate patients and caregivers.2, 4, 5


* Supplement nutrition.1,2, 4



The IHI recommends flagging patient records with a particular color or a sticker to remind caregivers to do pressure ulcer risk and skin assessment on admission. It also recommends reorganizing data collection forms to include a checklist for assessing pressure ulcer risk and skin, designating a pressure ulcer "champion" on each unit, dividing the institution's population into risk groups and addressing those at high risk first, and playing music over the public-address system at two-hour intervals to remind staff to turn patients.1


Nancy A. Stotts, EdD, RN, FAAN


Lena Gunningberg, PhD, RN




1. Institute for Healthcare Improvement. Five million lives campaign. Prevent pressure ulcers: getting started kit. 2006. [Context Link]


2. Wound, Ostomy, and Continence Nurses Society. Guideline for the prevention and management of pressure ulcers. Mount Laurel, NJ; 2002. Report 000-2002. [Context Link]


3. American Medical Directors Association. Pressure ulcers [Clinical Practice Guideline]. Columbia, MD; 1996. CPG2. [Context Link]


4. Virani T. Risk assessment and prevention of pressure ulcers. Toronto, ON: Registered Nurses' Association of Ontario, Nursing Best Practice Guidelines Program; 2005. [Context Link]


5. Folkedahl BA, Frantz R. Prevention of pressure ulcers. Iowa City, IA: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2002 May. [Context Link]