Page 71 - MALAYSIAN PATIENT SAFETY GOALS

ROLES AND RESPONSIBILITIES OF NURSES TOWARDS REDUCING
THE INCIDENCE OF HEALTHCARE ASSOCIATED PRESSURE ULCERS

2. Risk assessment and skin assessment

- Assess patient during admission to the ward using
Braden scale form (BKJ-BOR-PPK 20).

- Assessment should be done on every shift to those
patients who are prone or risk to get pressure
ulcer using form - (BKJ-BOR-PPK 13).
- Assess patient weekly using the Braden scale form

(BKJ-BOR-PPK 20).
3. Positioning patient every two hourly interval on ripple mattress

4. Mobilization of patient
- maximize activity and facilitate mobilization
- use of devices that assist individuals activity and

mobilization
5. Proper lifting and manual handling techniques to prevention of
shear and friction

6. Massage over bony prominences - rubbing stimulate blood flow
and increased oxygen and nutrition
7. Total relief pressure from the heels -use of heel protectors such

as gel/cushioned booties
8. Data Collection
- Data collection should be done every day by using

form - (BKJ-BOR-PPK 17).
- Data are collected and despatch to the Nursing
Supervisor every month using form –

(BKJ-BOR- PPK 18).
- Nursing Supervisor despatch the data to the
Quality Unit and State Health Department (JKN)

using form (BKJ-BOR-PPK 19).

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