Chronic wounds of the lower extremities impose an increasing burden on health care providers and systems, and they can have a devastating impact on patients and their families. These wounds include diabetic ulcers, venous ulcers, arterial ulcers, and pressure injuries. The estimated...
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.
Pressure Ulcer Prevention as Part of the Plan of Care
Based on the available resources we have at our disposal, it would be tempting to claim we have the pressure ulcer situation under control. Sadly, we all know that this is untrue. Skin care and prevention of pressure ulcers can and should be part of the life-saving plan. The interventions need not be complicated to be effective. If a patient develops a pressure ulcer—even though his life was saved—the morbidity and possible mortality associated with this event will most likely lead to litigation. That leaves many health care providers utterly perplexed when confronted with legal action. They ask "How can they possibly sue us? We pulled him back from the brink of death!" Gratitude flees quickly in the face of the pain and suffering experienced by the patient when a preventable pressure ulcer occurs.
Improving Patient Outcomes Through Evidence-based Practice
Specialization and evidence-based practice have improved patient outcomes for a variety of conditions. The flip side of this coin is the care of the entire patient can be compromised. This is especially problematic when addressing the risk factors associated with the development of pressure ulcers. Over the years, medical and nursing care of pressure ulcers has evolved from trial and error and 'that is how we have always done it' to carefully investigating and analyzing the science behind our interventions and tracking patient outcomes. When I was a nursing student in the mid-1970s, the standard treatment for 'decubitus care' was applying a liquid antacid and placing the patient under a heat lamp for 10 minutes at least twice a day. I shudder when I think of the damage we inflicted on our patients with nothing but the best of intentions.
Skin and Wound Care Practices Today
You will hear clinicians who would never dream of practicing medicine and nursing exactly the same way they did 30 years ago falling back on what they perceive as acceptable care for patients at risk for or presenting with a pressure ulcer. I STILL hear people promoting liquid antacids, povidone iodine, sugar, off the grocery shelf honey—the list seems endless. Yet they will swear their patient healed. My assertion is that some patients healed despite the awful things someone put on their wound. We need to apply evidenced-based practice in skin and wound care the same careful way we apply those principles to other aspects of health care.
Our body of knowledge has extended our ability to translate research into clinical practice. The practice and scope of monitoring patient outcomes that include large numbers of people are continually improving. Disseminating this information and changing practice improves patient care. Despite improved guidelines for care and standards of practice for skin and wound care, implementation of pressure ulcer prevention strategies and care have lagged behind other disease states. Again, we must ask ourselves "Why?" Our skin is the largest organ of our body and the one most likely to be taken for granted or ignored. Keeping our heart, lungs, brain, liver, kidneys, blood and other essential organs functioning in tip-top shape is the major focus of modern health care; we need to be just as vigilant in caring for what I like to call "God's gift wrap"—the skin.
About The Author
Paula Erwin-Toth has over 30 years of experience in wound, ostomy and continence care. She is a well-known author, lecturer and patient advocate who is dedicated to improving the care of people with wounds, ostomies and incontinence in the US and abroad.
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.