Pressure
Ulcers on the Increase
One
of my dear, elderly patients was recently
discharged from a teaching hospital after
undergoing surgery to repair a hernia. The
discharge summary claims the operation was a
complete success but notes that "the patient
developed heel ulcers during convalescence"
which will be "looked after by the community
nurses".
During my 30 years in general practice, I have
witnessed the increasing technical sophistication
of hospital care, but I still despair when I see
my patients develop stage 4 pressure ulcers on
their heels.
Sadly, my patients are developing pressure ulcers
far more frequently. Prevalence studies have shown
about one in 10 hospital patients has a pressure
ulcer. Is this just a reflection of our ageing and
increasingly frail population? Definitely not!
Pressure ulcers are mostly preventable, and
usually represent substandard care.
I was first introduced to effective pressure area
management while a resident doctor at Royal Prince
Alfred Hospital. Even though I reminisce through
the rose colored glasses of memory, regular
repositioning and an abundant supply of medical
sheepskins prevented even the sickest patient from
developing a pressure ulcer.
Lucy, my patient with the bilateral pressure
ulcers on her heels, was an active septuagenarian
looking forward to getting back to her lawn bowls.
Now she is confined to a chair with her
exquisitely tender, painful heels that must be
dressed every couple of days for the next three to
six months.
Had a medical sheepskin been placed under Lucy's
heels while she was on the operating table and in
the recovery ward, her months of agony could have
been avoided.
By providing a friction free surface and a dense
wool pile to redistribute the weight of her feet,
the medical sheepskin would have enabled Lucy's
vulnerable heels to be protected while she was
anaesthetized and as she was transferred from
table to trolley to bed.
Prevention
Rather Than Cure
The
Australian Medical Sheepskin with the unique
properties of its dense wool pile offers health
professionals a most versatile product for
preventing pressure ulcers.
It provides local pressure relief when placed
under the common sites of pressure neurosis such
as the sacrum, trochanters and heels. It offers
protection to patients where other pressure
relieving devices may be unsuitable such as those
with deformities and contractures.
Waterproofing is mandatory in health care
facilities but the use of impermeable plastic
covers causes moisture to accumulate at the skin
interface.
This moisture may simply be from normal insensible
perspiration or from the profuse sweating of
spinal cord damaged patients or from the
incontinent elderly. But when a medical sheepskin
is placed between the patient and the plastic
cover, wool's unique moisture absorption
characteristics keep the skin dry.
Patients with dry skin can be moved without
causing excessive shearing and frictional force.
There is less risk of capillary rupture with
concomitant deep ulceration and less risk of
superficial skin tears.
Easily transportable, the Australian Medical
Sheepskin stays beneath the patient as they move
from bed to trolley to chair to x-ray table and so
on.
Now that medical sheepskins can be laundered to
meet the most rigorous infection control
standards, they will be able to be used in the
operating theatre which is a common site of
pressure ulcer development.
Nursing
Support
Many
nurses have been reluctant to believe in the
efficacy of the Australian Medical Sheepskin
despite using the product successfully for
decades. They have fallen victim to the overseas
medical literature that has condemned
"sheepskin", a word that refers to at
best, a sheepskin without any Merino content or at
worst, a synthetic polyester pile, machine knitted
onto a synthetic fabric.
Genuine Australian Medical Sheepskins with their
dense wool pile courtesy of their Merino content,
have rarely been seen outside Australia let alone
described in medical literature.
Australians are lucky to have such a product
readily available for patients at risk of pressure
ulceration. The judicious use of medical
sheepskins in hospitals, nursing homes and the
community would certainly reduce the incidence of
pressure ulcers.
The above
report was submitted by:
Dr
Robert Carter
Medical Practitioner
Sydney
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