Avoidable versus unavoidable pressure ulcers
ARTICLE WRITTEN BY SYLVIE HAMPTON
If documentation is not done, then the care has not been given and in a Court Case, this would be a very dangerous situation for the nurse or carer. However, avoiding the ‘blame’ culture is simple. All the Courts ask is that the carer acts at a reasonable and competent level that would be reached by other nurse/carer of the same level. In pressure ulcer prevention this is BASIC nursing care. Providing equipment and repositioning and recording that this has been done. Simple!
The Department of Health (DH) was asked to clarify what an avoidable pressure ulcer is and they researched definitions and found a limited number of definitions in existence. The Wound, Ostomy and Continence Nurses Society of the US produced a position paper, which points to a clear definition of ‘avoidable and ‘unavoidable’ pressure ulcer.
Modified definitions are:
Avoidable Pressure Ulcer: “Avoidable” means that the person receiving care developed a pressure ulcer and the provider of care did not do one of the following: evaluate the person’s clinical condition and pressure ulcer risk factors; plan and implement interventions that are consistent with the persons needs and goals, and recognised standards of practice; monitor and evaluate the impact of the interventions; or revise the interventions as appropriate.”
Unavoidable Pressure Ulcer: “Unavoidable” means that the person receiving care developed a pressure ulcer even though the provider of the care had evaluated the person’s clinical condition and pressure ulcer risk factors; planned and implemented interventions that are consistent with the persons needs and goals; and recognised standards of practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate; or the individual person declined to adhere to prevention strategies in spite of education of the consequences of non-adherence”
In determining whether the pressure ulcer is avoidable; commissioners, regulators or others could request to see evidence demonstrating the actions outlined in the “avoidable” definition are demonstrated. (Position Paper, 2009.)