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Team Transformational Solutions

THERAPY AND SKIN BREAKDOWN PREVENTION PROGRAMMING 

Pressure ulcers (PUs) are a major burden to individuals, impacting their physical, mental and social wellbeing as well as a major focus of the nursing home. While pressure ulcer prevention is traditionally regarded as a nursing issue, an interprofessional approach has been promoted as best practice.

How many times have you heard someone say, “I didn’t know therapist could help with pressure ulcers”? Statements like this aren’t uncommon. The role of physical therapists, occupational therapists, and speech therapists care is commonly misunderstood but extremely beneficial in your skin breakdown prevention.

Pressure ulcers, now referred to as pressure “injuries” by the National Pressure Ulcer Advisory Panel (NPUAP), are defined as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence, or related to a medical or other device” and are considered generally preventable.1 Pressure “injuries” are costly. Additionally, patients may develop serious problems such as infection and scarring. Preventing pressure injuries begins with an accurate assessment of and treating of at-risk patients.  In addition to your nursing staff include your therapy staff as well.  An interdisciplinary approach can provide a patient centered approach and improve overall patient outcomes.

Appropriate use of the different therapy disciplines can provide significant pressure injury healing benefits for the patient. Physical therapy skilled services include such interventions as modalities (for example, electrical stimulation, ultrasound, and diathermy), edema management, positioning, orthotic use, and mobility. Occupational therapy can provide edema management, positioning, toileting programs, self-feeding, and wheelchair management. Speech therapy can address cognitive deficits, swallowing or chewing dysfunction, and nutrition management.

Physical and occupational therapists can also assess for positioning limitations and educate patients and staff in effective positioning methods that can prevent continued pressure to the area and further tissue breakdown. Physical therapists can assess the feet of patients with diabetes for deformities and high-pressure points. Performing a gait analysis can contribute to the proper use of effective offloading footwear and devices to allow neuropathic ulcers to heal and prevent future ulcerations.

Effective nutritional interventions can accelerate the proliferative phase of healing. Occupational therapists can assess the patient’s ability to self-feed and consume adequate amounts of protein and other nutrients needed for wound healing. Speech therapists can assess chewing dysfunction and dysphagia that impair the patient’s ability to chew and swallow these nutrients, leading to dietary recommendations to improve the patient’s overall nutrition. A speech therapist can also assess for cognitive deficits and educate the patient, family, and staff on how to effectively work with the patient, including ways to increase the patient’s nutrition intake.

Our facilities are working toward achieving great outcomes for skin care and have programs in place to do so.  By adding in the interdisciplinary approach we can go from good to Great!

-Sue Vincent – Regional Director of Operations – West, Team Transformation Solutions