What is the initial step in a pressure reduction protocol?

Initial Step in Pressure Reduction Protocol

The initial step in a pressure reduction protocol is to identify at-risk individuals through standardized risk assessment using validated tools such as the Braden Scale or Norton Scale, followed immediately by implementing specific prevention measures including patient repositioning, pressure-reducing surfaces, and nutritional assessment. 1, 2

Risk Assessment and Patient Identification

The foundation of any pressure injury prevention program begins with systematic identification of vulnerable patients:

• Use validated assessment tools - The Braden Scale and Norton Scale are the only two assessment instruments that have been extensively tested for reliability and validity in predicting pressure ulcer risk 1
• Assess intrinsic risk factors including limited mobility, poor nutrition, comorbidities, aging skin, sensory deficits, and circulatory disturbances 1, 2
• Evaluate extrinsic factors such as pressure, friction, shear forces, and moisture exposure 1, 2
• Perform early assessment in high-risk settings - For patients with prolonged ED stays prior to admission, initiate standardized pressure injury assessment and prevention protocols early in the ED stay, as longer boarding times correlate with higher rates of hospital-acquired pressure injuries 3

Immediate Prevention Interventions

Once at-risk patients are identified, three core prevention components must be implemented simultaneously:

1. Pressure Relief Management

• For non-weight-bearing immobile patients: Implement alternating pressure systems that achieve ZERO PRESSURE during each cycle, such as mattress replacement systems with three separate non-interconnected cells 1
• Establish repositioning schedule: Follow a patient repositioning protocol every 2 hours for immobile patients 1, 2
• Keep head of bed at lowest safe elevation to prevent shear forces 2
• Use pressure-reducing surfaces appropriate to the patient's mobility status 2

2. Nutritional Support

• Assess nutritional status immediately upon identification of risk 1, 2
• Provide supplementation if deficiencies are identified, as poor nutrition is a critical risk factor for pressure ulcer formation 1, 2

3. Moisture and Incontinence Management

• Implement incontinence management protocols as moisture is one of the four critical factors contributing to pressure ulcer development 1, 2

Common Pitfalls to Avoid

• Insufficient staffing for manual repositioning: Without dynamic alternating pressure systems, there is often insufficient staff to rotate patients every 2 hours outside intensive care settings, leading to preventable pressure ulcers with costs up to $60,000 per patient 1
• Delayed intervention: Waiting until after admission to begin prevention measures in ED patients with prolonged boarding times significantly increases hospital-acquired pressure injury rates 3
• Inadequate documentation: Failure to document initial risk assessment and prevention measures implemented compromises continuity of care 4, 3

Monitoring and Continuous Assessment

• Utilize objective monitoring tools including computerized pressure monitoring and laser Doppler skin blood flow measurement to assess effectiveness of interventions 1
• Reassess risk status regularly as patient condition and mobility change 4, 2
• Focus on high-risk anatomical sites - areas of skin overlying bony prominences are the most frequent sites for pressure ulcer development 1