Evidence-based guidelines for pressure ulcer management at the end of life
Abstract
It is important to develop an individualised plan of care for people at the end of life to prevent pressure ulcers, and to treat them if they do occur. This article discusses patient and risk assessment, prevention and care for pressure ulcers for the palliative care patient and the recommendations given in the palliative care section of the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014).
Individuals in the palliative care setting often have multiple comorbidities and risk factors, and are at high risk of pressure ulcer (PU) development,1,2 while others enter the palliative setting with an existing PU. In this setting, the usual goal and plan of care is to intervene with attempts to prevent PU development, and if the individual has an existing PU, to maintain and/or achieve progress towards wound closure and comfort for the individual.
It is, unfortunately, often overlooked that skin is the largest organ of the body and can fail along with the other organs.1,3,4 When vital organs are failing, expecting the skin ulcer to heal is generally unrealistic.1,4 People at the end of life are at moderate to high risk for developing soft-tissue ulceration.3,5,6,7 Literature is replete with reports that health care professional consensus is that PUs occurring at the end of life are often unavoidable, largely attributable to the individual's frail, compromised condition.1,2,8,9 Education of the individuals and their family along with question and answer sessions with the patient, family, physician and other health professionals will help clarify and establish the goal(s) of care desired by the individual and the significant other(s).
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