S - SKIN INTEGRITY
Implement pressure injury prevention strategies as part of the comprehensive management across the continuum and review all aspects of risk when determining prevention strategies. (Adapted from PU-PVA 2014, p.17; Level A)
Individuals with SCI, clinicians, and caregivers should conduct comprehensive head-to-toe visual and tactile skin inspections. (Adapted from PU-PVA 2014, p.17; Level C)
Directed by the individual with SCI, caregivers, clinicians, nurses, occupational therapists, assistive technologists, prosthetists, and orthotists should evaluate and monitor the individual with SCI and all of their support surfaces for optimal maintenance of skin integrity as directed by the individual with SCI. (Adapted from PU-PVA 2014, p.20; Level C)
If skin irritation due to moisture develops or persists, pursue a consultation with a health care provider with continence training for evaluation, topical treatment, and review of the bowel and bladder program. (Adapted from PU-ONF 2013, p.26; Level B)
Immediately after SCI, as emergency medical and spinal stabilization allow, review individual risk factors and implement appropriate pressure injury strategies, including using cervical, thoracic, lumbar precaution, limit the time the individual is on a spine board, and employ intraoperative pressure reduction strategies. (Adapted from PU-ONF, p.26; Level A/B)
Provide an individually-prescribed seating system designed to redistribute pressure and employ a power weight-shift system when manual pressure redistribution is not possible. (Adapted from PU-PVA 2014, p.21; Level A)
Assess nutritional status including dietary intake and losses, anthropometric measurements, nutritional and hydration-related blood work, ability to self-feed or dependence on others for eating and drinking, and other barriers to optimal food and fluid intake, regularly across the continuum of care as nutrition is a critical aspect for prevention of pressure injury. (Adapted from PU-PVA 2014, p.23; Level B)
Provide adequate nutritional intake to meet individual needs, especially for calories (or energy), protein, micronutrients (zinc, vitamin C, vitamin A, and iron), and fluids. (PU-PVA 2014, p.26; Level A)
Ensure that a qualified registered dietitian or nutritionist with experience in SCI performs the nutritional assessment, determines and recommends the appropriate interventions, and assesses the outcomes across the continuum of care. (Adapted from PU-ONF 2013, p.51; Level C)