Following the provision of accurate and relevant information about the healthcare intervention and alternative options available; and with adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention (Australian Commission on Safety and Quality in Health Care, 2020).

None of my narrative papers have been accepted for the new 2025 pressure ulcer prevention Guidelines. Yet my suggestions work… I can tell you how to have a pressure ulcer free facility.

References

Sharp CA Do Clinical Practice Guidelines for the Prevention of PUs really prevent PUs? An analysis based on the Guidelines. AJMS Vol 13 No 5 2022 1st June 2022

Sharp CA and Campbell J. Preventing pressure ulcers in aged care by auditing, and changing, work practices. AJMS Vol 13 Issue 4 April 2022

Human rights and litigation.

Sleep, like eating or drinking, is essential for living. Almost everyone has experienced the feeling of ‘falling to pieces’ after a night of poor sleep.

Sleep and Alzheimers

Gaur et al., (2022) described how inadequate sleep causes the aggregation of soluble amyloid beta protein and this may raise the likelihood of poor cognitive outcomes. One mechanism, they explained, is that, during slow wave sleep, the brain may be able to remove metabolic waste more effectively. In my opinion this puts an even greater responsibility on healthcare facilities to prioritise sleep for all patients and the main way this can be accomplished is to cease the two-hourly repositioning regimes, unless awake, use alternating pressure air mattresses, and let patients sleep.

Researchers are investigating the relationship between lack of sleep, or disturbed sleep, and a link with Alzheimer’s Disease (Gaur et al., 2022; Gobraeil, 2022). Therefore, it is imperative that patients are given the opportunity to sleep all night without being disturbed and to be informed of alternative therapies and strategies. Informed consent is a person’s decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made:

References

Dimond, B (2003). Pressure ulcers and litigation. Nursing Times, 99(5) 5 Dube, A (2021).

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review. Journal of Tissue Viability https://doi.org/10.1016/j.jtv.2021.10.007

Gaur, A., Kaliappan, A., Balan, Y., Sakthivadivel, V., Medala, K., & Umesh, M (2022). Sleep and Alzheimer: The Link. Maedica (Bucur), 17(1), 177-185. doi:10.26574/maedica. 2022.17.1.177

Ta-Wei Guu, Dag Aarsland, Dominic ffytche

Light, sleep-wake rhythm, and behavioural and psychological symptoms of dementia in care home patients: Revisiting the sundowning syndrome

2022

https://doi.org/10.1002/gps.5712

Gobraeil, S. Rizq, G (2022). What is the Relationship Between Sleep and Alzheimer’s Disease? A Narrative Review. URNCST Journal, 6(1). doi: https://doi.org/10.26685/urncst.334

In 1944 Ludwig Guttmann went into the hospital at night to see how nurses were preventing pressure ulcers. After he explained the importance of repositioning to the nurses, the problem dissipated but still teams of three orderlies and a nurse repositioned patients 24 hours a day to prevent pressure ulcers. There was no mention of sleep deprivation caused by repositioning.

References

Frankel, H. L (2012). The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries. Spinal Cord, 50(11), 790-796. doi:10.1038/sc.2012.109

Large cell alternating pressure air mattresses will prevent pressure ulcers. Geriatrician Mary Bliss.

Ventilated patients.

Nothing has changed in 58 years. All healthcare facilities run on a lack of nursing staff.

Foreseeable and Preventable

This is the moment in nursing history to introduce informed consent to prevent pressure ulcers in hospitals, the community and residential aged care, and allow patients to sleep. Because pressure ulcers are so painful failing to prevent them is a human rights issue.

REFERENCES

Bliss, M. R., McLaren, R., & Exton-Smith, A. N (1967). Preventing pressure sores in hospital: controlled trial of a large-celled ripple mattress. Br Med J, 1(5537), 394-397.

Bliss, M. R., & Simini, B (1999). When are the seeds of postoperative pressure sores sown? Often during surgery. BMJ, 319(7214), 863-864.

Glaser, J (2013). Fate of the contralateral limb after lower extremity amputation. Journal of vascular surgery, 58(6).

Poorly fitting bed rails have caused deaths where a person's neck, chest or limbs become trapped in gaps between the bed rails or between the bed rail and the bed, headboard, or mattress. Other risks are: rolling over the top of the rail or climbing over the rail.

Floor sensor mats can be placed around the bed or room and that can alert staff the moment an elderly person is wandering and at risk of a fall, allowing for immediate assistance. That’s fine but as I keep saying, if the staff are busy in another room helping a patient they will not be able to get to the wandering resident to prevent them from falling and breaking bones.

My preference is for one-on-one supervision 24/7. That means three nurses/carers every day as is Best Practice.

References

Healey F (2007). Bedrails — Reviewing the Evidence: A Systematic Literature Review, National Patient Safety Agency, London.

Nowicki, Tracy; Fulbrook, Paul and Burns, Cheryl. Bed Safety Off the Rails [online]. Australian Nursing Journal: ANJ, The, Vol. 18, No. 1, Jul 2010: 31-34

Preventing Falls and Harm From Falls in Older People Best Practice Guidelines for Australian Hospitals 2009 www.safetyandquality.gov.au

Many people who acquired polio in their childhood experience new or increased impairments decades after their initial infection, so-called post-polio syndrome or late effects of polio (LEoP) [1]. Common impairments in persons with LEoP are muscle weakness, muscle fatigue, general fatigue and musculoskeletal pain during everyday activities and physical activities. The causes of LEoP are not clear, but it seems that the new impairments occur due to a distal degeneration of axons in the enlarged motor units that developed during the recovery of the acute paralytic polio.

It is my experience as a nurse, that the LEoP are not mentioned in any falls risk screening tools in hospitals or residential aged care facilities and if staff don’t know about it they won’t know that a patient who may be able to walk around unaided may be at risk of falling because of the LEoP.

Now my story……

My preference is for one-on-one supervision 24/7. That means three nurses/carers every day – one on each shift.

References

Brogårdh C, Lexell J, Hammarlund CS. Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study. Int J Environ Res Public Health. 2021 Jul 5;18(13):7202. doi: 10.3390/ijerph18137202. PMID: 34281139; PMCID: PMC8295840.

Lexell J. Postpoliomyelitis Syndrome. In: Frontera W., Silver J., Rizzo J., editors. Essentials of Physical Medicine and Rehabilitation Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Elsevier Saunders; Philadelphia, PA, USA: 2019. pp. 834–840.

Dr Sherri Tenpenny podcasts and videos

Use the safe shoe checklist to assess footwear. This checklist is a reliable tool for evaluating specific shoe features that could potentially improve postural stability in patients. Discourage patients from walking in socks, because this is associated with a 10-fold increased risk of falling.164

This is particularly relevant in the hospital setting: patients should not walk in TEDs (antiembolism stockings) without appropriate footwear on their feet. Make sure that, while mobilising, the patient wears fitted, nonslip footwear (discourage the patient from moving about in socks, surgical stockings or slippers).

References

Koepsell T, Wolf M, Buchner D, Kukull W, LaCroix A, Tencer A, Frankenfeld C, Tautvydas M and Larson E (2004). Footwear style and risk of falls in older adults. Journal of the American Geriatrics Society 52(9):1495–1501.

For older patients suffering from delirium or cognitive impairment, where it is unsafe for them to mobilise or transfer without help, individual observation and surveillance must be increased, and help with transfers must be provided as required. Ideally, one-on-one supervision should be applied for those patients with a mobility impairment for which they lack insight (eg cognitive impairment), and who impulsively attempt to exit their bed or chair without assistance. A fall happens in a split second and if there is no nurse in the immediate vicinity it is more likely than not that the patient will fall, sustaining a life-threatening fracture.

There is evidence for the benefits of this approach from nonrandomised controlled trials. Bed exit alarms have not been assessed adequately in appropriate trials, but they are increasingly being used for similar patients, to alert nursing staff when a high-risk patient attempts to climb out of bed. I don’t think that more research is required to see whether these devices are effective in reducing falls rates in hospitals and residential aged care facilities.

My preference is for one-on-one supervision 24/7. That means three nurses/carers every day to remain with the patient the whole time.

References

Donoghue J, Graham J, Mitten-Lewis S, Murphy M and Gibbs J (2005). A volunteer companion-observer intervention reduces falls on an acute aged care ward. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services 18(1):24–31.

Preventing Falls and Harm From Falls in Older People Best Practice Guidelines for Australian Hospitals 2009. Australian Commission on Safety and Quality in Health Care (ACSQHC).