Pressure ulcer prevention work in nursing homes - a holistic approach

Pressure sores - a serious but often preventable care injury
Pressure sores cause great suffering for the residents and entail significant costs for the care. Through systematic work that combines risk assessment, nutrition, movement, and skin care, most pressure sores can be prevented.

Risk factors and early identification

Important risk factors
- Reduced mobility (bedridden/wheelchair-bound)
- Malnutrition and dehydration
- Aging skin with reduced elasticity
- Chronic diseases such as diabetes
- Incontinence with skin irritation

Risk assessment tools
- Use the Norton scale at:

• Move-in
• Deteriorating health condition
• Regular follow-ups (at least quarterly)
  - Document and communicate results in the care plan

Four cornerstones of preventive work

Pressure relief and positioning

Position changes
- Every 2 hours for bedridden
- Every 15-30 min for seated
- Use a rotation schedule and document

Aids
- Pressure-relieving mattresses (air/viscoelastic)
- Special cushions for hips, heels, and elbows
- Raise the head end max 30° to reduce shear forces

Nutrition and fluid

Dietary measures
- Protein supplement (1.2-1.5 g/kg/day)
- Energy-rich snacks
- Nutritional drinks as needed

Fluid balance
- At least 1.5 liters/day unless contraindicated
- Offer drinks regularly throughout the day
- Monitor signs of dehydration

Skin care and hygiene

Daily skin inspection
- Especially leg protrusions, hips, sacrum
- Look for redness that does not fade under pressure

Incontinence care
- Change protection immediately as needed
- Use barrier protective creams
- Soft washes without friction

Activity and exercise

Movement plan
- Customized exercise for each resident
- Seated exercise for wheelchair-bound
- Passive movement for bedridden

Promoting independence
- Encourage own movements
- Adapt aids for maximum participation
- Collaborate with physiotherapist/occupational therapist

Organizational measures

The role of staff
- Training in risk assessment and measures
- Clear routines for position changes
- Responsibility for documentation

The manager's responsibility
- Ensure access to aids
- Implement quality registries
- Prioritize training time

Interprofessional collaboration
- Occupational therapist for transfers, everyday support for staff and residents to strengthen the resident's independence and participation.
- Nurse for wound prevention, nutrition (sometimes with the support of a dietitian)
- Physiotherapist for movement plans, physical activity.

Documentation and quality follow-up

Structured documentation
- Risk assessments at regular intervals
- Skin status at each care occasion
- Measures and effect evaluation

Quality indicators
- Proportion of residents with pressure sores
- Time measurement from redness to action
- Staff knowledge testing

Reflection questions

Care personnel
- Which areas are hardest to inspect regularly?
- How can we make position changes more seamless in everyday life?

Manager, nurse, occupational therapist, and physiotherapist
- Are there sufficient resources for preventive work?
- How do we follow up on the effect of our measures?

Residents and relatives
- What information do you need about pressure sore risks?
- How can you help detect early signs?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day