The prevention of pressure ulcers can be a clinical challenge. Hemodynamic instability, immobility, and limited nutrition increase the risk for pressure ulcer development among critically ill patients. In this month’s issue, Cox discusses use of the Braden Scale for Predicting Pressure Sore Risk and the subscales to accurately predict a critically ill patient’s risk for the development of pressure ulcers. The 2 subscales that demonstrated significance in critically ill patients were mobility and friction/shear.
To avoid ulcers caused by immobility, turning and repositioning patients is recommended in all current practice guidelines, and new progressive mobility programs show promise in preventing several problems including pressure ulcers. Friction and/or shear may occur when a patient is agitated or slides down in the bed. Prolonged periods of head elevation such as that which occurs in mechanically ventilated patients or enterally fed patients also contributes to friction/shear in critical care patients.