Managing Pressure Ulcers at End-of-Life Care

Author

Chloe Burnett

Read Time:

2 Minutes

2 Min


End of life or palliative care is providing support for those who are in the last few months or years of life. End of life care helps those live as well as possible, and those providing care consider the wishes and preferences for the person as well as their care needs.

When a person is nearing the end of life they are at a greater risk of developing pressure sores. This is due to the limited mobility, or not eating or drinking as much. Meanwhile, incontinence can cause damage to the skin which makes it more difficult to keep the skin dry.

Pressure Ulcers and Skin Care

Changes in skin

Carers engaged in caring for those during the final stages of life have stated that despite delivering good skin care, some patients still develop pressure damage (Beldon, 2010).

The SCALE document, (Skin Changes at Life’s End) that was produced by experts, is widely recognised to this day within care environments. The SCALE document proposes that the skin, the biggest organ within the body is not resistant to dysfunction at the end of life, resulting in varying degrees of skin/tissue damage which includes pressure ulcers.

Managing Pressure Ulcers at End-of-Life

The SSKIN tool is a common method that many carer providers follow for pressure ulcer prevention:

S- Surface:

  • Providing the right support (foam or air pressure care mattress)
  • Removing draining tubes and other medical equipment which a person can be laid on
  • Using cushions if necessary

S-Skin:

  • Inspecting the skin, detecting any changes early
  • skin colour
  • temperature
  • swelling
  • hardness or softness compared with surrounding skin

K-Keep Moving:

  • Help the person change their position, carrying out turning plan either manually or using an automated lateral turning system as part of plans
  • Using appropriate equipment, such as wedges, pillows, slide sheets or mechanical lifts, to help people move in and out of bed without damaging skin

I-Incontinence:

  • Help keep skin clean and dry
  • Use barrier cream or film to help protect skin from excess moisture

N-Nutrition:

  • Ensuring the person is eating well and drinking fluids

Did you know?

Despite delivering good skin care, some patients still develop pressure damage

(Beldon,2010)

Outcomes

As opposed to healing the pressure ulcer, the focus for someone at end of life is around making sure they are comfortable. Pressure ulcers can place physical and mental strain on the person and care givers, so it is important that pressure care management is carried it effectively and attentively.

Useful Guides

 Sources:

  • Beldon, P (2010) Skin changes at life’s end (SCALE): a consensus document. Wounds uk, 2010, Vol 6, No 1

  • NHS UK 2022. What end of life care involves. [online] Available at: <https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/#:~:text=End%20of%20life%20care%20includes,and%20your%20family%20or%20carers.> [Accessed 18 February 2022].

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