IMPROVING THE HEALING OF PRESSURE ULCERS 2
Improving the Healing of Pressure Ulcers in Older Patients
Improving the Healing of Pressure Ulcers in Older Patients
The subject for research:
Effectiveness of negative pressure wound therapy in improving the healing of the pressure ulcer in older patients aged above 60.
For elderly patients above 60 years with pressure ulcers (P), will negative pressure wound therapy (I) as opposed to standard moist wound therapy (C) improve the healing of the pressure ulcer (O) during their two-week stay at the hospital (T)?
Project Purpose Statement: Improving the Healing of Pressure Ulcers in Older Patients
In general, Older patients, age 60 and older, hospitalized or in long term care facilities, are at risk for the development of pressure ulcers secondary to sitting in one positions and lying in the same positions for a an extended period of time (Bauer, Rock, Nazzal, Jones, & Qu, 2016). Causes of such ulcers are friction from the bed; when a patient is constantly in bed their skin and the bed may rub or be in contact so much that it causes friction, and consequently, pressure wounds. Also, pressure wounds can be caused by pressure being exerted on a certain part of the body by the bed or some points in a bed, causing pressure wounds on the area (Bauer, et al., 2016). It is the nurses’ responsibility to assess the skin for any evidence of pressure ulcers and to provide care that can ensure such ulcers do not occur. Taking care of them is very important, and the method used to care for the wounds is a great determinant of how long the wound takes to heal. Negative wound pressure therapy and standard moist wound therapy are among the methods of taking care of a wound. This paper will highlight the benefits of using negative wound pressure therapy over standard moist wound pressure therapy to heal pressure wounds in patients aged above 60.
Background & Significance
Older people suffering from pressure ulcers may be unable to take care of the ulcer themselves. Lack of care has been shown to lead to
Older people may be unable to wash and keep the wound moist as required for healing. For the standard moist wound therapy, the wound needs to be kept clean by regular washing and moisturizing for it to heal. This may be a lot for older people, and they may fail to follow up on the wound as required and, therefore, they take longer to heal. This exposes the wounds to infections, which can be harmful to the body and sometimes deadly. They can cause other complications like blood poisoning if they are left unattended. Therefore, they may require the help of a caregiver. Pressure wounds or ulcers mostly occur at the joints. If not well taken care of or go a long time before closure and healing, they can cause infections in joints and lead to amputation or harmful bone infections (Bauer, et al., 2016). They can cause cancer, and sepsis, a condition characterized by inflammation of internal organs due to the release of chemicals to fight infections in the body.
Wounds that are left open and unattended can get dirty and infected. Infections on the wound can cause deeper infections in the bones. Similarly, the germs or bacteria causing infection can also travel through the blood stream, infecting it. In turn, the blood cells release chemicals to fight the infection, which can make internal organs to swell, driving the body into sepsis which is fatal. Some wounds are also malignant, and due to constant pressure on them they keep recurring or refuse to heal altogether, making them malignant and cancerous (Bauer, et al., 2016). Because of the risk for pressure ulcers in the older population who are immobile because of hospitalization in long term care facilities, it is important that wound care be appropriate so as to prevent aforementioned complications. This project aims to find a faster solution for pressure wound treatment to avoid the risk of infection, cancer, and sepsis in older patients aged over 60 years. Over 60,000 people die every year from pressure wound infections (Bauer, et al., 2016).
The standard moist wound therapy is a method of care for pressure ulcers whereby the wound is washed using water and soap to remove any dirt; for moisture retention, petroleum jelly may be used. Then the wound is left to heal over a period of time (Atkinson, & Cullum, 2018). Negative pressure wound therapy is the process of applying a vacuum on the wound through the dressing, which is completely sealed. A vacuum pump is attached to the dressing, which then works on healing the wound by sucking out any fluid in the wound area, thus prompting better blood flow for faster healing (Atkinson, & Cullum, 2018). It stimulates granulation tissue formation, hence speeding up the entire healing process. This helps the wound close much faster, reducing the risk of infection and reducing any swelling chance. If the patient is discharged, this vacuum-assisted closure VAC machine can be switched to a similar one that the patient can use at their home’s comfort (Black, & Kalowes, 2016).
Standard moist wound therapy works well for wounds that are not too deep (Atkinson, & Cullum, 2018). Treating deep wounds using the standard moist wound method can harm a patient since it may take too long to close and heal, exposing the patient to a potential health consequence. Since pressure wounds occur mostly at joints and from tissue tears, they are sometimes deep and may take time to heal, especially if they keep recurring because the patient may keep the same posture that contributes to the pressure wounds, especially if te they are in long term care facility (Atkinson, & Cullum, 2018).
Treating using standard moist wound therapy may expose the patient to the risk of infection and prolonged healing. Negative pressure helps reduce these risks by providing an alternative in which the wound remains covered and dressed. This ensures that the wound remains under the dressing and is not exposed to any infections (Atkinson, & Cullum, 2018).
This project aims at finding a way to reduce the time required for an older person to heal from pressure wounds, reducing the risk of infection and the complications that come with it. The PICOT project findings could show that negative pressure wound therapy promotes faster healing of the older patients compared to standard moist wound therapy. In this case, a big change can be anticipated in the number of reported cases of complications resulting from wound infections, which reduces the number of deadly complications like sepsis in older patients due to pressure wound infections. This will help in the reduction of pressure wound mortality from 60,000 per year (Bauer, Rock, Nazzal, Jones, & Qu, 2016).
PICOT Formatted Project Question
The PICOT study population would be adults aged over 60 years who are already in the hospital and suffering from pressure wounds. The intervention would consist of treating the pressure wounds using negative pressure wound therapy for some patients and standard moist wound therapy for others. The group consists of 50 patients who are over 60, with deep pressure wounds; 25 using the negative pressure wound therapy for the treatment of their pressure ulcers while the other 25 use standard moist wound therapy to treat their wounds, to compare which of the two methods promotes faster healing of the pressure ulcers. The expected outcomes would be the healing of pressure wounds of the people using negative pressure wound therapy and delayed healing for the patients practicing the standard moist wound therapy to treat their pressure ulcers by the end of two weeks.
Approximately 60,000 people die from complications resulting from pressure wounds. Infections on a pressure wound can increase the risk of mortality by 55% (Bauer, et al., 2016). Negative pressure wound therapy as a way of treating wounds reduces infection risk altogether compared to the standard moist wound therapy (Papp, 2019). Infections can cause death and other complications for the patient. Using negative pressure wound reduction reduces the time in which the wound heals, thus reducing the patient’s time struggles with a wound. The longer a wound stay exposed, the higher the risk for infection, putting the patient’s life in danger. This project will illuminate the difference in the time required to heal while using both the negative pressure wound therapy and standard moist wound therapy on older patients in the hospital, and consequently endorsing the method that allows faster healing of the pressure wound as a safer way of dealing with pressure wounds as it reduces infection risks.
Atkinson, R. A., & Cullum, N. A. (2018). Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord, 56(3), 186.
Bauer, K., Rock, K., Nazzal, M., Jones, O., & Qu, W. (2016). Pressure Ulcers in the United States’ inpatient population from 2008 to 2012: Results of a retrospective Nationwide study. Ostomy/wound management, 62(11), 30-38.
Black, J. M., & Kalowes, P. (2016). Medical device-related pressure ulcers. Chronic Wound Care Management and Research, 3, 91-9.
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.
LIMA, R. V. K. S., COLTRO, P. S., & FARINA JÚNIOR, J. A. (2017). Negative pressure therapy for the treatment of complex wounds. Revista do Colégio Brasileiro de Cirurgiões, 44(1), 81-93.
Papp, A. A. (2019). Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction. International Wound Journal, 16(2), 394-400.