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.
Why Is Pressure Ulcer/Injury Prevention Left on the Back Burner?
I have been a wound care nurse since 2000. To this day, I struggle with understanding why we have an array of pressure wound assessment tools, over 6,000 wound care products and devices, and we continue to have such a high rate of pressure ulcer/injury occurrence across the globe. The other frustration I have is after a patient develops an ACQUIRED in-house pressure wound, the administration and nursing staff become frantic and immediately want to beef up the nursing staff education, rent a new type of preventive device, and stock new advanced wound care dressings. Where was the prevention mindset?
Diabetic Foot Ulcer Risk Factors
A Pressure Ulcer/Injury Prevention Mindset Goes a Long Way
The list of at-risk patients is a long one and includes:
- Patients living in assisted living or nursing homes
- Patients with hospital stays
- Patients receiving home health care
- Patients undergoing dialysis
- Patients with spinal cord injuries
- Neonatal patients
- Bariatric patients
And the list goes on...these folks are ALL AT RISK because they have a diagnosis that warrants further care. My mindset has always been EVERYONE IS AT RISK. We can continue to tally up numbers, but the bottom line is that these folks are at risk the minute they enter your care. Perform your assessments and use your risk management tools, but also use your PREVENTION MINDSET and think of the WHOLE PATIENT. Implement pressure ulcer/injury prevention interventions immediately. DO NOT WAIT.
Importance of Accurate Pressure Ulcer/Injury Risk Assessment Tools
The most common risk assessment tools used are the Braden Scale for Predicting Pressure Sore Risk© (adult) and the Braden Q Scale for Predicting Pediatric Pressure Ulcer Risk (child or infant). The accuracy of any risk assessment is dependent on the nurse's understanding of the multiple risk factors and the six domains where the numbers are accumulated for a total score. Evaluate your nurses to ensure they know and understand the six domains within the Braden Scale (sensory perception, moisture, activity, mobility, nutrition, friction/shear). I have been in many long-term care facilities where the Director of Nursing has approached me about doing an in-service on how to correctly perform the Braden Scale. Their facility had been cited for an acquired in-house pressure injury/ulcer, and the risk assessments were the same total score for months, even though the patient's health had substantial changes. Maybe the nurse didn't understand fully how to perform the Braden Scale, or maybe they were short staffed and copied the last numbers. Barbara Braden concluded after 25 years of developing the Braden Scale that the scale, supplemented with good nursing judgment, provided a reliable method of addressing pressure ulcer risk factors in an individual patient.1,2
Ongoing Education on Pressure Ulcer/Injury Prevention and Risk Assessment Tools Is Key
Health care professionals and caregivers should be encouraged to focus on a prevention mindset. This focus, along with ongoing education, will help bolster quality of care across the continuum. We want to maintain skin integrity and provide a plan of care that is whole-patient centered. Overall, empirical evidence using risk assessment tools is not the most impressive because of performance errors. There continue to be debates on the usefulness of risk assessment tools for this reason.
Risk assessment tools are useful if used correctly. Education on prevention and using risk management tools correctly is essential. Take into consideration that patients who are at the end of life will most likely have a rapid increase in risk and development of pressure ulcer/injury.
1. Braden BJ. Prevention Plus. Home of the Braden Scale. http://www.bradenscale.com/. Accessed September 29, 2019.
2. Warner-Maron I. The risk of risk assessment: pressure ulcer assessment and the Braden Scale. Ann Longterm Care. 2015;23(5):23-27.
About the Author
Cheryl Carver currently works as a Clinical Wound Specialist for American Medical Technologies in the San Francisco Bay area. Her experience includes over 20 years in wound care and hyperbaric medicine. Cheryl has received many high reviews as a nationally recognized wound educator and has been invited to speak to interdisciplinary audiences all over the world. Cheryl single-handedly developed a comprehensive educational training manual for on-boarding wound care physicians, as well as many other published white papers and articles. She was the first LPN to be accepted into the Association for the Advancement of Wound Care (AAWC) Speakers Bureau. Cheryl is also an active AAWC member and Ambassador, Diplomat (DAPWCA) with the American Professional Wound Care Association, and Fellow (FACCWS) of The American College of Clinical Wound Specialists. Cheryl enjoys traveling, writing, and is currently pursuing her Bachelor of Science degree in Communications with an emphasis on Journalism.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.