By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
The challenge of preventing pressure ulcers is won through our frontline staff—the patient’s caregivers. Caregivers deliver most of the pressure ulcer preventive interventions, such as turning and repositioning, floating the heels, and managing incontinence. That’s why it’s imperative to communicate the patient’s plan of care directly to the caregivers.
Preventive programs start with a risk assessment and the development of the plan of care, which is then shared with the caregiver. At a minimum, you should communicate the following:
- turning and repositioning plan
- type of support surface that’s on the bed and the need to check for proper inflation* before leaving the room
- type of wheelchair cushion
- how to float the heels
- positioning devices
- incontinence management
- nutritional monitoring and supplements
- notifying the nurse if a wound dressing is soiled, loose, or missing
- inspecting the skin daily and notifying the nurse if any concerns are found
- notifying the nurse if the patient has chosen not to follow one or more interventions.
*Ensure that the bed is set at the proper setting and is plugged in and turned on if it’s a powered surface, and that the patient is not bottoming out. (The National Pressure Ulcer Advisory Panel defines bottoming out as a mattress or support surface that compresses when a hand is placed palm up under it so that the support materials feel less than an inch thick, which results in the patient’s bony prominences making contact with the underlying surface.)
Both verbal and written communication is needed, and be sure information is provided in the caregiver’s preferred language.
Communication is a two-way street: It’s also important for caregivers to contribute to the plan of care. Have them keep a notebook (either print or electronic) in which they can communicate any changes that the nurse or other clinicians should be aware of and record care tips or updates. If the patient is in the acute care setting, have the caregivers, nurses, and other interdisciplinary team members read the communication book before they start their shift and initial that they have read it.
Care for the caregivers
Keep in mind that caregivers may be coping with their own challenges as they care for their loved ones. These may include their own health problems, the challenges of running a household (sometimes while still working full time), and the need to manage finances. It may be helpful to refer caregivers to support groups or to such resources as the Caregivers page on MedlinePlus and the Caregiver Action Network, which has useful tips. (See 10 tips for family caregivers.)
Cornerstone of care
Communication is the cornerstone to ensuring effective and consistent care for our patients. Making certain that the voices of caregivers are heard and communicating with them effectively will improve their ability to provide appropriate care and help prevent pressure ulcers.
Jeri Lundgren is vice president of clinical consulting at Joerns in Charlotte, North Carolina. She has been specializing in wound prevention and management since 1990.
DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.