RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Assessment & Management of Stage I to IV Pressure UlcersOther criteria for the selection of an interactive dressing include:■ Provision of thermal insulation and wound temperature stability (CREST, 1998);■ Protection from contamination of outside micro-organisms (AHCPR, 1994; CREST, 1998);■■Maintenance of dressing integrity, not leaving residual fibres or foreign substances within the wound(Consortium for Spinal Cord Medicine, 2000; CREST, 1998);Lack of trauma to wound bed on removal (Compliance Network Physicians, 1999; CREST, 1998); and■ Is simple to handle, and is economical in cost and time (CREST, 1998).Caregiver time is a significant consideration when selecting a dressing. Caregiver time and staff costscontribute significantly to expenditures related to pressure ulcer care (AHCPR, 1994; Consortium for Spinal CordMedicine, 2000; Ovington, 1999). In her review of the AHCPR recommendations, Ovington (1999) describes aliterature base that includes multiple, clinical, randomized, controlled studies that have documented thatcaregiver labour costs can exceed the cost of supplies in wound management. The use of moistureretentivedressings for wound management in general (i.e., not limited to pressure ulcers) has also beenreviewed, and the impact of these dressings on reducing caregiver time and overall cost-effectiveness hasbeen supported in the literature. For example, one RCT (Kim, Shin, Park, Oh, Choi, & Kim, 1996) found that therewas a difference in average treatment time for clients with Stage I and II pressure ulcers from 20.4minutes/day (hydrocolloid group) to 201.7 minutes/day (wet-to-dry gauze dressing group). The hospitalcost of ulcer treatment was higher in the gauze group compared to the hydrocolloid group – these resultsindicate that the hydrocolloid occlusive dressing technique offers a less time consuming and less expensivemethod of treatment compared to conventional techniques.Current knowledge about wound care principles, assessment parameters and the variety of dressingoptions allows healthcare providers to select the right dressing for the wound. The choice of dressing is aclinical one, and is based on the assessment of the individual, the pressure ulcer(s) and the overall goal ofcare. This choice is not static, and care providers must be vigilant in recognizing conditions that require achange in the treatment plan and a different dressing (Baranoski, 1995; Consortium for Spinal Cord Medicine, 2000).Factors to consider when selecting a dressing include:■ Etiology of the wound (Baranoski, 1995; CREST, 1998)■ Client’s general health status, goals of care and environment (Baranoski, 1995; CREST, 1998; Maklebust& Sieggreen, 1996)■ Site of the wound (AHCPR, 1994; Consortium for Spinal Cord Medicine, 2000; CREST, 1998; Day, Dombranski, Farkas,Foster, Godin, Moody et al., 1995; Ovington, 1999)■ Size of the wound, including depth and undermining (AHCPR, 1994; CREST, 1998; Maklebust & Sieggreen, 1996)■ A dressing that will loosely fill wound cavity (AHCPR, 1994; Consortium for Spinal Cord Medicine, 2000)■ Exudate – type and amount (AHCPR, 1994; Compliance Network Physicians, 1999; Consortium for Spinal CordMedicine, 2000; Ovington, 1999)■ Risk of infection (Consortium for Spinal Cord Medicine, 2000; Compliance Network Physicians, 1999; CREST, 1998)■ Type of tissue involved (Baranoski, 1995; Compliance Network Physicians, 1999; CREST, 1998)■ Phase of the wound healing process (Compliance Network Physicians, 1999; CREST, 1998)■ Frequency of the dressing change (AHCPR, 1994; CREST, 1998; Ovington, 1999)■ Comfort and cosmetic appearance (CREST, 1998)■ Where and by whom the dressing will be changed (AHCPR, 1994; Baranoski, 1995; CREST, 1998)■ Dressing availability (CREST, 1998)44