Approaching Pressure Ulcers: Removing Blame from the Care Equation

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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.

For example, the case of the elderly person who fell and was found later by a family member or friend. The person may say it was only 30 minutes before assistance arrived, but time can be difficult to track when you are upset and ill. The person may have been there for many hours before someone realized they were in need of help. Now what if this person broke their hip? Surgical repair is usually done immediately, but if the person has multiple serious health conditions, then further medical examination is needed to be sure surgery is the best option. This may mean the person is sedated for the pain resulting from their injury and immobilized for an additional day.

Now when a deep tissue injury appears on day three of this patient’s stay, where did it come from? Look back at the risk assessment and care plan and determine if everything was done correctly. List the risk factors that occurred before hospital arrival and pre-surgery, and what education the patient and family were given. In the case of the fall patient, a number of risk factors are present that make determining the source of the pressure ulcer development difficult to determine. If any deficiencies are noted in your facilities care approach, plan ways to correct them in the future. Be positive, constructive and open to learning from the experience to improve overall patient care in your facility rather than blaming others.

About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.


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.

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