Assessing Skin Integrity to Reduce Pressure Ulcer Risk in Diabetes

This report investigates the relationship between diabetes and the development of pressure ulcers, highlighting the significance of skin integrity assessment in mitigating risk. A literature review, utilizing databases like Medline, PubMed, and Cinahl, was conducted to analyze relevant articles published between 2015 and 2019. The PICO question focused on whether skin integrity assessment, compared to neuromuscular assessment, reduces pressure ulcer risk in diabetic patients. The review of various studies, including systematic reviews, randomized controlled trials, and observational studies, suggests that skin assessments and preventive care bundles are effective in pressure ulcer prevention and management. Furthermore, staff education and training play a crucial role in improving awareness and compliance with preventive measures. The report concludes that while skin assessments are beneficial, further research is needed to explore pressure ulcer management specifically among diabetics, and risk factors associated with epidural anesthesia should be carefully considered.

Pressure Ulcers in Diabetes
Name of the Student:
Name of the University:

Introduction/Background
• Diabetes often increases the susceptibility
to pressure ulcer acquisition due to
hyperglycemia-induced inadequate blood
circulation and peripheral neuropathy.
• Wound and pressure ulcers, due to
diabetes, have been associated with
approximately 40, 000 annual
amputations in the United States (Bauer
et al., 2016).

Methodology
• An electronic literature search was
conducted using databases like Medline,
PubMed and Cinahl.
• Keywords included: ‘diabetes’, ‘pressure
ulcers’, ‘assessment’, ‘skin integrity’
‘neuromuscular’ along with Boolean
Operators.
• Articles published within 2015 – 2019 and
of relevant to the key words were
included (McGowan et al., 2016).

PICO Question
• PICO Question: In diabetic patients does
skin integrity assessment compared to
neuromuscular assessment reduce the
risk of pressure ulcer?
• P (Patient): Diabetes patients
• I (Intervention): Skin Integrity assessment
• C (Comparison): Neuromuscular
assessment
• O (Outcome): Reduction of Pressure Ulcer
risk.

Literature Review: Results &
OutcomesCitation Design Level of Evidence Findings
Baines, McGuiness, W &
O'rourke, (2017)
Systematic Review Level I External beam of
radiotherapy may result in
unpredictable outcomes
such as skin damage,
absence of damage or
acute symptoms. Skin
assessments are used
negligibly, require clinical
validation and is needed to
refine existing pressure
ulcer assessment.
Coyer et al., (2015) Randomized controlled
trial
Level II Patients receiving the skin
integrity bundle (inSPire)
reported reduced
incidence and severity
pressure ulcer incidence
as compared to those
receiving standard care.
Skin assessments are
integral to prevention and
management of pressure
injuries.
Edwards et al., (2017) Longitudinal Pre-Post
Design
Level IV There were reduced
incidences of pressure
injury wounds after
implementation of the
Champions for Skin
Integrity’ model. There

Citation Design Level of Evidence Findings
Janowska et al., (2018) Systematic Review Level I Administration of epidural
anesthesia can be
considered as key method
in the management of
pressure ulcers. Risk
factors like hypothermia,
motor block, lower limb
paralysis and vertebral
canal hematomas must be
considered.
Sardo et al., (2016) Retrospective Cohort
Analysis
Level IV The first skin assessment
among 7132 patients lead
to detection of 1455
pressure ulcers and proves
to be an important
measure of frailty.
Tayyib, Coyer, & Lewis, (2016). Observational prospective
study
Level VI Administration of
implementation strategies
such as training,
education, audit and
feedback increased
nursing compliance with
administration of pressure
ulcer prevention bundle.
Tayyib, Coyer & Lewis, (2015). Randomized Controlled
Trial
Level II Intervention group
receiving pressure ulcer
prevention bundle
reported reduced
incidence and
development of pressure

Conclusion
• Skin assessments and preventive care
bundles are effective in pressure ulcer
prevention and management.
• Staff education and training can improve
awareness, usage and compliance.
• Further research is required to explore
pressure ulcer management among
diabetics.
• Risk factors underlying epidural
anesthesia must be considered.

References
Baines, C. R., McGuiness, W., & O'rourke, G. A. (2017). An integrative review of skin assessment tools used to evaluate
skin injury related to external beam radiation therapy. Journal of clinical nursing, 26(7-8), 1137-1144.
Bauer, K., Rock, K., Nazzal, M., Jones, O., & Qu, W. (2016). Pressure Ulcers in the United States' Inpatient Population
From 2008 to 2012: Results of a Retrospective Nationwide Study. Ostomy/wound management, 62(11), 30-38.
Coyer, F., Gardner, A., Doubrovsky, A., Cole, R., Ryan, F. M., Allen, C., & McNamara, G. (2015). Reducing pressure
injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE). American Journal of Critical
Care, 24(3), 199-209.
Edwards, H. E., Chang, A. M., Gibb, M., Finlayson, K. J., Parker, C., O'reilly, M., ... & Shuter, P. (2017). Reduced
prevalence and severity of wounds following implementation of the Champions for Skin Integrity model to facilitate
uptake of evidence‐based practice in aged care. Journal of clinical nursing, 26(23-24), 4276-4285.
Janowska, A., Dini, V., Pradal, M., Davini, G., & Uccelli, F. (2018). Pressure Ulcers After Epidural Anaesthesia.
In Science and Practice of Pressure Ulcer Management (pp. 151-157). Springer, London.
McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C. (2016). PRESS peer review of
electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology, 75, 40-46.
Sardo, P. M. G., Simões, C. S. O., Alvarelhão, J. J. M., e Costa, C. T. D. O., Simões, C. J. C., Figueira, J. M. R., ... & de
Melo, E. M. O. P. (2016). Analyses of pressure ulcer point prevalence at the first skin assessment in a Portuguese
hospital. Journal of tissue viability, 25(2), 75-82.
Tayyib, N., Coyer, F., & Lewis, P. A. (2015). A two‐arm cluster randomized control trial to determine the effectiveness of
a pressure ulcer prevention bundle for critically ill patients. Journal of Nursing Scholarship, 47(3), 237-247.
Tayyib, N., Coyer, F., & Lewis, P. A. (2016). Implementing a pressure ulcer prevention bundle in an adult intensive
care. Intensive and Critical Care Nursing, 37, 27-36.