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Preventing Pressure Ulcers and Bed Sores

Pressure ulcers are skin injuries caused by prolonged pressure. Commonly known as bedsores, these abrasions result from staying in one position for too long. They often appear on body parts where the skin is close to the flesh, like ankles, hips, heels and the tailbone.

Eight months ago, Lourdes hospitals began using a unique monitoring device called the Leaf Patient Monitoring System with a goal of reducing the incidence of pressure ulcers, sometimes called bed sores, that occur at hospitals.

Since that time, Lourdes has had a hospital-wide average of 90 percent patient-turn (repositioning of the patient) compliance, among the best of the hospitals working with Leaf Healthcare.

Maria Brennan, DNP, RN, discusses how to prevent pressure ulcers, improve patient comfort and reduce hospital stays exacerbated by this condition.
Preventing Pressure Ulcers and Bed Sores
Featured Speaker:
Maria Brennan, DNP, RN
Maria Lariccia Brennan, DNP, RN, CPHQ, has been appointed Chief Nursing Officer and Vice President, Patient Care Services for Lourdes Health System and St. Francis Medical Center. In her role, Brennan is responsible for patient experience, staff engagement, quality and performance, and professional practice models and care delivery systems.

Learn more about Maria Brennan, DNP, RN

Melanie Cole (Host): Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions can bring pain, associated risks for serious infections, and increased healthcare utilization. My guest today, is Maria Brennan. She is a Registered Nurse and the Chief Nursing Officer at Lourdes Health System. Maria, what are pressure ulcers, and who is most at risk for them?

Maria Brennan (Guest): Pressure ulcers are a breakdown for first in the skin and the tissue below the skin. Usually, they occur when patients are debilitated, first of all, and in one position for too long. Patients who are at risk usually are elderly patients, patients who have a multi-system failure — they have many things going on with them — diabetic patients, patients with what we call comorbidities — multiple disease entities.

Melanie: Where do you see them occur most on the body?

Maria: In the sacrum — on the back, just in the buttocks area. That’s because patients tend to lay on their backs the majority of the time they are in the hospital — usually 80% of the time. A key prevention strategy for pressure ulcers is turning the patients least every two hours.

Melanie: Do we know what causes them?   Why is laying on their back an increased risk for these kinds of pressure ulcers? What’s happening there?

Maria: Because when you lay on your back — or any part of your body. you could be on your side for a prolonged period of time, the blood flow to that area is decreased, and when the blood flow is decreased the tissue begins to break down —- and the tissue below the skin.

Melanie: How quickly does that happen? Are there levels or stages where it starts to happen just a little bit? Are there certain stages?

Maria: Yeah, there are. There are really five stages. Stage one is just redness. Stage two is a breakdown where the skin actually breaks down, and you see a sore — a beginning of an opening. And then, stage three and four is the depth of the sore, and then there is also — well, we don’t call it stage five. It’s unstageable.

Melanie: Are these actually infected, these sores, or are they just as you say, a breakdown in the skin — they put you at risk of infection, but are they necessarily infected sores?

Maria: They are not necessarily infected. Most of them are not infected, but there is a high risk of infection once you do break down.

Melanie: And how long can these things take to heal?

Maria: Oh, months, months. The deeper the wound, the longer the healing process.

Melanie: Wow, so let’s speak about something that you have at Lourdes Health System, called the Leaf Monitoring System. What is this, and how does it work?

Maria: The Leaf monitoring system is you place a sensor on the patient on their chest, and the sensor detects what position the patient is in, how long they’re in that position, and also, it can detect the blood flow in the area where the patient is laying on. Say the patient is on their back, it could detect decreased blood flow to that area to give us an indication that you need to turn the patient.

Melanie: Maria, who is getting that information? Will that be available at the nurses’ station?

Maria: We have it in multiple places. We do have a centralized monitoring system at the nurses’ station where all nurses and caregivers can see it — nursing assistants, as well. The nurse assigned to the patient has it on what we call the WOW — their personal computer that they do their medications on, their charting on, and they get the Leaf monitoring on that computer, as well.

Melanie: Where does the family fit into this monitoring of pressure ulcers — because it’s a problem once you get the patient at home as well if this is a patient that is bedridden — is this something that you could foresee families being able to use?

Maria: It could be installed in homes eventually. Right now, it is made for nursing homes in acute care settings, but it is a possibility for the future. I think the best thing that we can do right now with the families is to describe what a pressure ulcer is, teach families how to treat it, make them aware of the importance of turning the patient when they are caring for them at home and the angle that’s best for them to be turned so that the maximum blood flow to the area. Patient education and family education is really important.

What we also see with the Leaf Monitoring System, not only are we decreasing hospital-acquired pressure ulcers, but if patients are coming in with them, they are healing once they’re on the system.

Melanie: But even somebody like physical therapists can use this monitoring system, correct — for ambulation and keep track of movement of the patient?

Maria: It’s really meant for when the patient is in bed — it does track movement of the patient, so we can tell what side the patient is on when the patient moves. When they’re walking, we would know that they’re walking. The whole team is involved because early ambulation and getting out of bed is extremely important, but the main caregivers for maximum utilization of Leaf are the nurse and the nursing assistant.

Melanie: Does the patient feel it?

Maria: Feel the Leaf? No, it’s almost like the cardiac monitoring. It’s a little — it’s not even a pad. It’s just a little device. It does not hurt the skin, or even sensitive skin we have has no problems with patients wearing this small, small device — is the best way to put it. It’s about the size of a silver dollar.

Melanie: Before we were talking about the Leaf, you were mentioning turning patients, but what else can you do to prevent these in the first place, and what are you also, Maria, want families to know if they’re sitting with their loved ones and making sure that they’re hydrated or if they are turned — what do you want them to know about keeping that healthy skin for a bed-ridden patient.

Maria: Well, like I said, turning is extremely important; ambulation is important if the patient can ambulate. If they can’t, and they’re totally bed-ridden, turning is great. But another thing that’s very, very important to prevention and healing of a pressure ulcer is good nutrition. Getting the right amount of protein into the patient is extremely important because that promotes healing. It’s nutrition; it’s hydration, it’s turning, movement, and keeping the skin dry. If they’re incontinent, change them as soon as the incontinence occurs. It’s a lot of family education for the patient who is going home and is bedridden.

Melanie: Maria, you just mentioned keeping the skin dry — and I think a patients’ family member would right away assume that they would want to put cream on the patient's skin — ?

Maria: Near a wound, I wouldn’t recommend a moisturizer, okay? I would just recommend cleaning it. Keeping them dry, I was just referring to incontinence — wetting the bed or having a bowel movement in the bed, getting them cleaned right away -- as soon as they recognize that the patient is wet or had a bowel movement, cleaning that right away, making sure that you pat them dry with a towel. You can use moisturizer on the patient, just not near the wound.

Melanie: What about things like powder — talcum powder?

Maria: Powder really is not recommended anymore.

Melanie: It’s not?

Maria: No, that’s not —

Melanie: People would think of it as something that would help reduce that friction, but not really. Wrap it up, Maria. As a nurse and somebody who sees these kinds of things every day — and the Chief Nursing Officer — what do you want other patients, clinicians, family members to know about the Leaf monitoring system and possibly preventing pressure ulcers before they even begin?

Maria: Well, I think for us and for many of the hospitals that were in the trial, the average reduction of pressure ulcers — hospital-acquired — was 73%. At this time, here at Lourdes, we have reduced our pressure ulcers by 83%, so that’s wonderful for the patients. You never want a patient to break down. I think the key relationship with Leaf is that the nurse is reminded when to turn the patient. Having that reminder — it’s on their computers constantly, so they know when to go into the room; they know when to make the turn, and they’re very aware. The nurses get busy and in the past may have forgotten to turn them every two hours. Now, they have this reminder, and we have a 90% or over compliance rate with turning.

I think for family members, and other members of the healthcare team need to be aware that we have this technology. If the technology isn’t available, the two takeaways I’d like patients and families to know about pressure ulcer prevention is good nutrition, good hydration, and turning or ambulating every two hours — executives of course, while you’re sleeping.

Melanie: Thank you so much, Maria. That’s really important information, and what an interesting situation now with that Leaf monitoring system. How cool is that? Thank you again for being with us. This is Lourdes Health Talk. For more information, please visit, that’s This is Melanie Cole. Thanks, so much, for listening.