First Things First

• Patients should have a patient risk and skin assessment completed on admission and documented in the medical record.
• Assess risk for skin breakdown using a consistent, validated tool, such as the Braden or Norton scale, every time it is done.
• The patient risk assessment must include several components: mobility, incontinence, sensory deficiency, presence of friction and shear forces, and nutritional status and should be incorporated into the admission process.
• Other risk factors for pressure ulcers include presence of pressure ulcers on admission, advanced age, body weight, sensory deficiency, comorbid conditions, glycemic control, low blood pressure, circulatory abnormalities, dehydration, long operative cases and the use of vasopressors.
• Critically ill patients have risk factors and conditions that do not fit with existing risk assessment tools and can hamper early identification and offer possible rationale for increased incidence of breakdown.
• Patients that are identified as being at risk require early interventions to prevent pressure ulcers
• These interventions should include minimizing pressure with the appropriate bed surface, mobilization, nutrition, managing moisture and paying special attention to at-risk areas.