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COVID-19 and pressure ulcer prevention

Coronavirus (MERS-CoV) which was first recognised in September 2012* has swept through the UK and all tissue viability training has been stopped for now. See below for some tips on reducing your risk of pressure ulcers in this time. I hope it helps:

As care providers, looking after residents with the risk of flu is not new. The number of flu cases and deaths due to flu-related complications varies each flu season.

“The average number of deaths in England for the last five seasons, 2014/15 to 2018/19, was 17,000 deaths annually” (Public Health England).

What is new is that as vaccines are considered the most effective protection against the flu and are readily available each year, this is something that has not been developed to fight against the coronavirus yet.

There are also reports of the degree this particular virus attacks the lung function with upsetting reports of not enough ventilators to support patients. As a result dramatic measures have been taken to minimise contact and for those in care they are lucky enough to have you caring for them.

They may be high anxiety about lack of social contact with their families and worry of contracting the virus.  From feedback received, below may be some of the causes of increased risks of developing pressure ulcers due to COVID-19 in long term care and possible mitigating solutions:

Increased rapid admissions

As hospitals have an increase in COVID-19 they are already seeking private hospitals and even hotels to find beds for patients. There is already reports of a huge surge in Nursing Home facilities putting extra pressure on you. Firstly ensure that risk assessments are clear on discharge and repeat on admission. Use the aSSKINg model to reassess their pressure care needs and identify risks and create a care plan around these needs. 

Use the below poster around the home or in staff areas to prompt staff to remember these key elements of prevention. Its when we are super busy that the basics can get missed.

Flu and reduced mobility

The standard flu can knock any of us off our feet and many of your residents will be likely to become more immobile. If you are experiencing an increase in admissions of residents from hospital, they may have likely been more immobile while in hospital. The great thing about you as a 24 hour care setting is the continuous prompting to mobilise. For those that remain challenging to repositioning look at alternatives such as an enhanced support surface like the OSKA Series5 lateral tilt. This cannot replace a manual turn but offers a 10-20% tilt on a 20 minute rotation offering a degree of offloading for the very high risk and bed bound resident. Give me a call if you would like further advice about using this mattress.

Low mood and reduced mobility

One of the already reported complaints of social isolation is low mood. Your residents are likely to stopped having home visits by relatives and grandkids which before they may have looked forward to. The use of Skype or FaceTime is great for interaction but not quite the same. If any of us are feeling low we may become more sedentary. The last thing you want to do is exercise. However, exercise has shown to significantly improve mood by realising endorphins into our system. Introducing residents to gentle exercises especially as a group activity may help alleviate these symptoms AND offload those pressure areas! Seating acquired pressure areas are common in nursing homes, so if your resident is able, get them to rock from side to side every 2 hours for 30 seconds or push up from their chair off their bottom for 30 seconds. For tips and ideas give me a call or ask the Facebook Champion page.

Device related pus

Increased use of oxygen and ventilators mean device related pressure ulcers may increase. These can be challenging to prevent as putting anything too thick between the device and the skin can cause problems. Some tips I have used in practice: 

  • Dermal pads, these are silicone pads that can be cut to size, ask your GP but the two leading on the market are Kerrapro and Derma pads. 
  • Prophylactic soft silicone edge dressing such as Mepilex or Allevyn Border. These act as a soft cushion and stay in place once cut to size.
  • If using catheter tubing, ensure the leg bag is not pulling and consider use of leg straps from your catheter provider.
  • See NHS poster of examples of MDPUs

Lack of training access

So I can continue to support you through this time I have set up a virtual training academy where I can present training for up to 4 hours via a secure video conferencing site called Zoom. I can also do this via the SKYPE platform.

For those that haven’t used Zoom or Skype you will just need:

  • Computer and internet access.
  • For 1-1 meetings a laptop or desktop screen. For group training a laptop you can plug into projector or TV screen.
  • No sign up is required for zoom from your end- you will be sent a link to join the class and will be able to click on this to see training slides, hear me present and ask questions. You may also be able to record or download the taring materials.

I will continue to offer virtual training sessions in:

  • Pressure Ulcer Prevention, categorising & management.
  • Wound care Management and dressings.
  • Root Cause Analysis (RCA) Investigating our harms.
  • CQC journey to outstanding in pressure care and improvement plans.
  • Bespoke Tissue Viability Training as requested.
  • 1-1 virtual Tissue Viability support.

I am also aware how the acute sectors will be keen to clear as many beds as possible which may mean increased admissions for complex patients to nursing and residential homes so if I can be of any help with advice please do give me a call.

Many may not know that along with the 1.4million nhs staff there are 1.6million care staff both in care settings and within patients own homes who are continuing to provide their essential services.

I cannot write this with out humbly thanking this group from the bottom of my heart for such amazing care and dedication you show every day. You have very lucky residents to have you.

Every day you leave your own homes and family to provide this vital care without which lives would be at risk!

Thank you for all you do.