According to the National Pressure Injury Advisory Panel (NPIAP) definition, “A pressure injury is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.” Pressure injuries are an...
by Janet Wolfson, PT, CLWT, CWS, CLT-LANA
In March of 2017, regular readers of this blog may recall "Making a Daily Difference in Preventing Pressure Injuries." I imagined a wonderful facility where staff went about their duties with a corner of their brain always attentive to how patients' diagnoses, activities, and comorbidities could affect the tendency to develop a pressure injury (ulcer). Magically, the appropriate prevention occurred.
A year ago, after quite a challenging month in pressure injury prevention, I, along with everyone at our facility, embarked on this plan. The blog was shared with administration. My dreamlike plan got a real-world makeover.
Be a Wound Warrior Every Day
Real world requires some champions and cheerleading. Encouraging signage went up. (Float Every Heel, Every Time, Every Day). Every staff meeting had me singing my song and thanking everyone for their efforts, but also sharing success and failures. Even staff engagement activities weren't exempt. Rehab week was focused on superheroes with a costume day. I did not take a photo, so you will need to imagine how amazing I appeared as "Wound Warrior!" Wound Warrior thanked everyone, knowing that it is the everyday hero that prevents pressure injuries as patients are turned, cleaned, moisturized, given a pillow, and staff were hired... (Save applause for end of blog, please.)
If anyone bumped into me, I was into, "had we gotten a supply delivered, how was staffing for the night shift, have you tried the new moisture barrier spray, can we leave extra pillows in the room after it's cleaned, have you seen the new protocol for heel care, which of your patients are at risk, is this patient incontinent and do they have our barrier product in the room..." Then, I started awarding StepUp Points—a hospital reward system—to reinforce the activity.
At some point, coincidentally, I was invited as a permanent member to all patient team meetings, and behold: all team members knew who had a pressure injury or Braden/BMI /incontinence that put them at risk. The rehab scheduler also added a HIPAA-compliant notation to the rehab schedule to help fulfill corporate initiatives to prevent worsening of existing pressure injuries.
Skin protocol got a prevention upgrade, and staff were re-educated. New moisture-associated skin dermatitis care products were evaluated, and staff were educated on their use before application to at-risk skin. Rounding on high-risk patients was added into my weekly rounding. Patients and families, of course, heard my song and noticed my dandy cart posters.
Everyone's favorite day—National Pressure Injury Prevention Day—was celebrated by the entire hospital. Staff were "caught in the act" by our physicians completing a task or providing care that prevented pressure injuries. They were acknowledged verbally and with StepUp Points. This culminated in the afternoon with staff attending a gathering to acknowledge that we ALL have a role in prevention. How folks were "caught" was shared with pride. Root beer FLOATS (get it?) were sipped. A fun Medical Device-Caused Pressure Injury Prevention sticker game reminded all that it is not just the buttocks and heels that are at risk.
Continuing the Fight
Of course, the need for daily perseverance goes on. A pressure injury slips through the cracks, and the RCA reveals our HD patients need champions. Because of the invisible nature of most risk factors, it is not always obvious that this patient's heels really, really do need to be floated… so let's float ALL heels. (Float Every Heel, Every Time….) My new poster is "Turn Every Cheek." A work in progress.
So, this may seem routine and even a bit corny. But over the course of a year, we reduced our incidence from two to four heel pressure injuries per month to zero to two per month. That is a success, but I know we are not there yet and may never be. Wound Warrior may need to make another special appearance.
About the Author
Janet Wolfson is a wound care and lymphedema educator with ILWTI, and Lymphedema and Wound Care Coordinator at Health South of Ocala with over 30 years of field experience.
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.