Page 43 - Retail Pharmacy March 2021

to offload the pressure effectively. “It’s important to mention that the once popular doughnut cushion is an example of bad offloading. What these cushions do is apply more pressure to the surrounding area so the perfusion of blood to the area you want to offload is further compromised. Doughnut cushions are not at all the right treatment for pressure injuries. “There’s a whole science around seating and sleeping offloading surfaces. While there’s no evidence one product is better than the other, they all have a role to play. We do, however, need to recognise the solution lies in offloading pressure, not simply transferring it elsewhere. This means regular and frequent movement to ensure relief is given to all areas.” Prevention better than cure Professor Carville says that when a patient or carer presents in the pharmacy seeking relief for a pressure injury, they typically will ask for something soft to relieve pressure on the affected area, but seeking softer support surfaces isn’t the correct way to approach the problem. “The first question to ask is, ‘Do you/ they have any sore spots on the skin?’,” she said. “Find out if the patient can move independently, too, because those that can’t move independently are high risk. “Also, ask if the patient finds they slide down the bed or the chair regularly, because when they pull themselves up it causes shear, which is different to pressure but a major cause of pressure injuries, particularly when shear and pressure are combined. “The patient’s nutritional status is a factor, too. If their tissues are well nourished, they’re going to be able to tolerate more pressure and shear, while less healthy skin will be more susceptible to damage. “Carers and those in pharmacy being asked for help with wounds affecting the elderly should always be aware that pressure injuries start with what may seem fairly innocuous symptoms.” “The other thing is what’s called the ‘microclimate’ of the skin, which includes the temperature and the moisture level. If the skin is damp or at an increased temperature, the tensile strength is going to be weakened. “Often, we see plastic against the skin to protect the chair or the mattress in case of incontinence. The problem is the plastic traps heat and moisture, resulting in a reduction to the skin’s tensile strength. “The keys to avoiding pressure injuries include optimising skin health, including good nutrition and hydration. The skin must be clean with an appropriate level of moisture, but certainly not damp.” Professor Carville adds that even with healthy skin, people need to be repositioned, or prompted to be HEALTH WOUND CARE 41 repositioned regularly. This can be challenging, because when a patient is advised to reposition – for example, every two hours – no one follows the clock, and it doesn’t get done. “One of the things I do if people are watching television is advise they change position with every commercial. Of course, if people can’t do it due to cognition issues or immobility, they need to be repositioned by their carer to ensure pressure is offloaded effectively.” Treating pressure wounds When the steps mentioned above aren’t followed and pressure wounds do develop, it’s important that they’re treated appropriately. Many pharmacies have trained wound care specialists, and a range of resources are available to support those treating patients with wounds. Carers and those in pharmacy being asked for help with wounds affecting the elderly should always be aware that pressure injuries start with what may seem fairly innocuous symptoms. A level 1 pressure injury may present as intact skin with non-blanchable redness of a localised area, usually over a bony prominence. Darkly pigmented skin may not have visible blanching, and its colour may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler compared with adjacent tissue. If in any doubt, always refer to a wound specialist or medical practitioner. TO PAGE 42 RETAIL PHARMACY • MAR 2021