Pressure Ulcers

Editor's Note: How can a multidisciplinary approach aid in pressure injury prevention? In this interview, Kelly McFee, DNP, FNP-C, CWS, CWCN-AP, FACCWS, DAPWCAshe discusses how using the multidisciplinary approach to prevent PIs has helped her practice, along with promoting education and the use of prophylactic dressings.

By the WoundSource Editors Nurses and other health care professionals providing care to patients regularly face challenges that can make it more difficult to perform routine tasks and ensure patient comfort and well-being, especially with regard to pressure ulcer/injury prevention and treatment. From a lack of mobility to chronic diseases, these challenges often coincide and interplay, creating unique risks and complications in managing the care of patients. To address these issues effectively, it is important to be aware of key best practice techniques for preventing pressure injuries and to stay proactive. This blog provides a brief overview of three of the most common patient challenges related to pressure injury prevention and offers strategies for effectively addressing each.

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 Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN Health care professionals recognize there seem to be 'seasons' for certain diseases and conditions. Spring and fall see a rise in flare ups of gastrointestinal disorders, such as inflammatory bowel diseases and seasonal allergies. Summer months bring an increase in traumatic events such as drownings, gunshot wounds and automobile accidents. Development of pressure ulcers does not follow a seasonal pattern—they occur at a higher than acceptable frequency throughout the year.

By Karen Zulkowski DNS, RN, CWS Taking a positive approach when a pressure ulcer develops at your health care facility usually isn’t the first thing that comes to mind. However, it should be. When a patient develops a pressure ulcer the first thing that usually happens is the blame game: It wasn’t our fault—it must have happened at the (take your pick) nursing home, hospital, OR, ER, etc. In reality, the pressure may have happened prior to the patient’s arrival at the facility.

By Karen Zulkowski DNS, RN, CWS How many of you know how knowledgeable you are about wounds? Keeping up with the latest articles and treatments is difficult. This is especially true for a staff nurse that only encounters patient wounds occasionally. Larger facilities and home health agencies have wound nurses, but smaller facilities do not. Pressure ulcer knowledge has been examined for Registered Nurses across the United States using the Pieper Pressure Ulcer Knowledge Test. When urban versus rural nurses' knowledge was examined between rural Montana nurses and urban New York City nurses all scored at a "C" level. Similar testing at a Florida VA found nurses score 77% and only improved to 81% after education programs. Registered nurses that participated in the New Jersey Hospital Association pressure ulcer collaborative scored slightly higher on the Pressure Ulcer Knowledge test at 83%. However, percent correct is still a "B-" average. Certified wound care nurses scored at 93%.

Pressure injuries are among the most significant health and patient safety issues that health care facilities face daily. Aside from the strong impact on patients’ quality of life, they also have high costs of treatment, not just to the patient, but also to the health care industry. The Agency for Healthcare Research and Quality reported $20,900 to $151,700 per individual patient and pressure injury in health care costs. The prevalence of present-on-admission (POA) pressure injuries is 26.2% among those admitted to the hospital from a nursing home and 4.8% among those admitted from another living setting. Hospital-acquired pressure injuries (HAPIs) cost the US health care system $9.1 to $11.6 billion a year.

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC It's November, and most people are thinking about turkey, stuffing, pumpkin spice, and the fall colors. But I think of Worldwide Pressure Ulcer Prevention and Awareness Day (November 19, 2015), National Caregivers Month, and how I can help. I have shared a holding sign video and personal photos on social media to share my story in hopes of educating others. My passion for wound care is driven by my mother dying in my arms at the young age of 47, due to complications of diabetes and stage IV pressure ulcers.

By Margaret Heale, RN, MSc, CWOCN It has become quite easy to look at pressure ulcer prevention in most health care settings. From acute care, through the ED and on to the OR and ITU, then to the various floors of med surg, orthopedic, not forgetting rehab and community nursing. Pediatric and neonatal units have better defined pressure ulcer risk assessment tools to utilize that have made assessment and planning care much less haphazard for those patients than in the past.

A nurse recently shared some of her experiences as a charge nurse in a skilled facility during the COVID-19 pandemic. She worked evenings (3-11:30 pm) at a local facility and was overwhelmed by the high number of patients she was responsible for. She typically worked on a 26-bed floor with just one nurse assistant for the shift. She later transferred to the night shift, where she was the only person on a 16-bed unit for the 8 hours. When asked how she was able to reposition patients as frequently as was recommended, the nurse said that she did “the best I could.” She is, unfortunately, not alone.