Pressure Ulcers

By Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP

Often when we hear the words "pressure injury," our brains are trained to think about staging the wound, considering treatment options, and obtaining a provider's order for care. Ideally, when we hear the words "pressure injury," we should think prevention! As Benjamin Franklin once said, "an ounce of prevention is worth a pound of cure." This is a very true statement and speaks volumes to our goals of care and education format when developing pressure injury prevention curriculum for our facilities.

By the WoundSource Editors

Pressure injuries represent a great challenge in patient care, as well as a significant burden on the health care system. This burden is likely to continue to increase as a result of the growing geriatric population, along with the increasing rates of obesity, diabetes, and cardiovascular disease. Recent estimates in the United States show annual costs of pressure injury treatment to be approximately $9.1 to $11.6 billion. In addition to cost, these localized injuries to the skin are often very painful for patients, particularly as the injuries become more severe.

By the WoundSource Editors

Pressure injuries require complex care. They can be incredibly painful for patients, and they represent an enormous financial burden on the health care system. Nationally, pressure ulcers cost between approximately $9.1 and $11.6 billion annually to treat. A subset of these patients includes those who are particularly prone to developing pressure ulcers as a result of comorbid conditions. This subset includes patients who may have cognitive disabilities, those who have a spinal injury or have undergone an amputation, and bariatric patients.

By the WoundSource Editors

Pressure injuries are a significant risk for patients and pose a tremendous clinical challenge to medical providers. Serious pressure injuries can present a substantial threat to patients' survival when comorbidities are present, and even less serious pressure injuries can negatively affect a patient's comfort and well-being. Although some pressure injuries are unavoidable, best practices in patient skin care can greatly reduce the risk in many circumstances, with some research demonstrating that up to 95% of pressure injuries are preventable.

By the WoundSource Editors

With aging populations facing increasingly complex comorbid medical conditions coupled with polypharmacy and multidrug-resistant organisms, wound healing can often feel like an uphill, never-ending battle. There are often elements that cannot be allayed, and some factors will always be outside the control of the patient and the practitioner. Barriers that can be eliminated should be, but sometimes compliance is a concern.

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

Worldwide Pressure Ulcer/Injury Prevention & Awareness Day is November 21st. This day is considered pretty much a holiday at my home. I have Stop Pressure Ulcer tee shirts, and I order a cake or STOP sign cookies every year from the bakery in memory of my mother. To some it might sound crazy, but my life was strongly impacted forever in 1996 after my mother passed away in my arms at only 47 years old because of complications of diabetes and what was called at that time "multiple decubitus." The image and smell will never leave my mind. It changed my life forever as a daughter, a caregiver, and later as a wound nurse. I needed more answers to heal my heart. How could my mother acquire such horrible wounds while at the hospital to get better? My mind was twirling nonstop with the 5Ws. Who, what, when, where, why? So, then it began. I wanted to learn everything I could. This ended up being sort of my therapy, which transitioned into my passion and purpose.

By Heidi Cross, MSN, RN, FNP-BC, CWON

Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

By the WoundSource Editors

The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. When utilized on a regular basis, standardized assessment tools, along with consistent documentation, increase accuracy of pressure injury risk assessment, subsequently improving patient outcomes. Conversely, inconsistent and non-standardized assessment and poor documentation can contribute to negative patient outcomes, denial of reimbursement, and possibly wound-related litigation.

by Kelly Byrd-Jenkins, CWS

It may come as no surprise to some, but pressure ulcers are among the only hospital-acquired conditions that have been on the rise in recent years. Other hospital-acquired conditions—such as adverse drug events, falls, and catheter-associated urinary tract infections—have decreased, according to a statement by the Agency for Healthcare Research and Quality in January of this year.

By Ivy Razmus, RN, PhD, CWOCN

People in wheelchairs are limited in their mobility, sensory perception, and activity. These limitations can lead to increased temperature and moisture on the areas that are in contact with the wheelchair surface. These risk factors place wheelchair users at a higher risk for pressure injuries. A pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. Pressure from medical devices against the skin may also cause pressure injury. Patients with spinal cord injury (SCI) and its associated comorbidities are among the highest-risk population for developing pressure injuries. The incidence of pressure ulcers in patients with SCI is 25%–66%.