Pressure ulcer prevention and care: a survey of current practice

The incidence and management of pressure ulcers in hospitalised patients is an ongoing concern for nurses. Efforts to prevent pressure ulcer development are plagued with inconsistencies and a general lack of best practice guidelines. Establishing current practice approaches to the assessment, prevention and management of pressure ulcers is a necessary first step in the implementation of evidence-based/best practice guidelines. Anecdotal evidence suggested a range of different approaches were being used in a Sydney metropolitan area health service (AHS) to assess patients to identify those at risk, to prevent pressure ulcers and to treat existing ulcers. A collaborative research project was undertaken to examine current practice and to explore the apparent clinical variance. It involved the distribution of a questionnaire to registered nurses working within the AHS (n = 2113) and a review of nursing policy documents in the various hospitals in the health service area. While the overall response rate was satisfactory (40%) many of the returned questionnaires were incomplete. Only 21% (n = 444) of the questionnaires were deemed suitable for analysis. The findings highlight a range of inconsistencies within and across nursing practice domains. Nurses generally do not use a tool to assess pressure ulcer risk potential, but rely on a range of practice procedures and risk indicators to determine risk potential of developing pressure ulcers. Repositioning patients is the most common approach used in an attempt to prevent the development of pressure ulcers, but additional measures are diverse. Most nurses seem to be familiar with modern wound dressings such as hydrocolloids, foams and alginates in the treatment of second and third stage ulceration. However, the care provided by some nurses reflects an adherence to outdated practices, including the use of water filled gloves, povidone iodine and gauze packing.