Table 1.

Pressure ulcer prevention strategies applied in the Palliative Care Unit at Independent Public Healthcare Railway Hospital in Wilkowice–Bystra, Poland

I. Risk assessment and management of pressure ulcers

1. Comprehensive medical and nursing assessment (including patient mobility, nutritional status, edema, inspection for skin lesions especially in areas of bony prominences) with pressure ulcer risk evaluation (Waterlow scale23) at admission for all patients using a standardized individual patient questionnaire

2. Regular pressure ulcer risk reassessment once a week or more frequently if patient state deteriorates

3. Collaboration with the therapeutic team to determine the optimal management of each patient

4. Additional pressure ulcer prevention strategies applied if the Waterlow scale score ≥10 points

5. Yearly analysis and review of pressure ulcer development statistics and assessment of prevention strategy effectiveness

6. Regular staff training focused on pressure ulcer risk assessment and pressure ulcer prevention and treatment

7. Patient and caregiver education (including adequate hydration, feeding, dressing, and physical activity maintenance)

II. Management of increased pressure ulcer risk

1. Patient mobility and frequent body position adjustment is encouraged

2. Proper body positioning and turning at least every 2 hours if patient mobility is impaired

3. Appropriately lifting and moving patients with sufficient personnel to avoid injury

4. Utilization of pressure-reducing or pressure-relieving devices (eg, alternating pressure mattress)

5. Instructing and assisting patients to shift their weight at least every 30 minutes when using a wheel chair

6. Skin inspection during assisted body positioning and bathing

7. Gentle skin bathing (once a day and when needed, mild hypoallergenic soap, skin folds, and opposing skin surfaces; thorough drying of skin with special attention given to skin folds; application of moisturizing lotion or emollient)

8. Patients given soft cotton or linen underwear and clean, dry, wrinkle-free bed linen, which is replaced when necessary

9. Effective skin protection from contact with urine and feces

10. Adequate hydration and feeding (with a focus on proper protein intake)

11. Individualized rehabilitation programs, including physiotherapy, for maintenance of mobility

12. Continued patient and caregiver education aimed at patient mobility and cooperation