Module 8 - Pressure Management
Pressure ulcer prevention
The wheelchair cushion has been one of the usual suspects in causing pressure ulcers for wheelchair users. However, it should not be overlooked that there are a complex array of risk factors that contribute to pressure ulcer development, and rarely will a single cause be the sole factor.
"It should be clear by now that wound prevention and pressure management involve more than just swapping cushions. The contributing factors and circumstances can be varied and complex and changing. In most cases it may be impossible to single out one element in the event and pronounce it as the primary offender. It is a multi-dimensional problem. The solution is also multi-dimensional and should be approached that way. Deal with cushion issues, but don't forget the other issues."
"In defence of the wheelchair cushion" - accessed 2008
The document "Skin Care and Pressure Area Prevention in Patients with Spinal Cord Injury", produced by the NSW State Spinal Cord Injury Service (SSCIS) in 2008, identified the underlying principles in pressure ulcer prevention as:
- risk assessment
- skin inspection
- return to seating protocol
- pressure relief
- continence management
- skincare hygiene
- nutrition
- evaluation environment
- equipment prescription
- exercise regimen
- education
- seeking advice.
Read more
Risk assessment
The Waterlow Scale was found to have highest predictive value in patient with SCI when compared to Braden and Norton Scales (Wellard and Lo, 2000).
As clients with SCI are likely to be rated at high risk in these scales, it is important to carefully select suitable equipment and implement precaution strategies as suggested in the module.
Read Neurological changes due to SCI to interpret your findings from the initial interview (Module 2) in relation to the client's pressure risk. Please refer to the above documents for full details on risk factors and skin management in acute, rehabilitation and community settings.
Prevention of pressure ulcers should be
- client-centred
- proactive
- holistic
- engaging with multidisciplinary team for consultations.
This module will address pressure management in issues related to seating and wheeled mobility equipment prescription.