Pressure Injuries

Holly Hovan's picture
neuropathy testing for sensory perception (Braden Scale)

By Holly M. Hovan, MSN, GERO-BC, APRN, CWOCN-AP

As wound care professionals, the Braden Scale for Predicting Pressure Sore Risk® is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of Braden Scale use may contribute to a multitude of different scores. The resident behaves differently on different shifts, for example, being asleep on the night shift but up and about on days. What is the correct way to score these patients? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, during transfer, when receiving, and most importantly, with any change in condition.

Diane Krasner's picture
wound care documentation

By Diane L. Krasner, PhD, RN, FAAN

Scope of Practice and Standards of Practice guide nurses and other members of the interprofessional wound care team in caring for patients with wounds. Documentation in the medical record is a key aspect of the standard of practice and serves to record the care delivered to the patient or resident. Your documentation should follow your facility guideline for documentation. Accurate documentation helps to improve patient safety, outcomes, and quality of care.

This WoundSource Trending Topic blog considers general wound documentation dos and don'ts and presents 10 tips for success. Good, better, and best documentation examples are included for each tip.

WoundSource Practice Accelerator's picture

Patients who develop stage 3 and 4 pressure injuries with prolonged wound chronicity and complexity may require surgical intervention. One surgical method used to encourage healing in pressure injuries is flap surgery, which involves taking a section of skin with an intact blood supply and placing it over the injured area. Flaps play a major role in the healing of wounds with exposed structure. Flap surgery can help prevent hospitalization and decrease morbidity. Flap surgery is used to prevent and resolve complications, including surgical site infections and other infections, dehiscence, recurrence, flap necrosis, nutrient deficiencies, and prevention of future malignancy (Marjolin ulcer) and seroma or hematoma.

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When pressure injury prevention fails as a result of non-adherence, various comorbidities, or gaps in care, it makes a major impact on the nation’s economy and has estimated costs of more than $100 billion in the United States.

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WoundSource Practice Accelerator's picture

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.

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The coronavirus disease 2019 (COVID-19) pandemic has forced health care professionals to take a closer look at the most effective and appropriate measures for pressure injury prevention. In 17% of all COVID-19 cases pneumonia secondary to acute respiratory distress syndrome is the most common complication; therefore, prone positioning is used as an adjuvant therapy. The prone position allows for dorsal lung region recruitment, end-expiratory lung volume increase, and alveolar shunt decrease. To be most effective, this position should be maintained for 10 to 12 hours, thereby increasing prolonged pressure on certain areas of the body. However, prone positioning should be supervised and monitored regularly by nursing staff experienced with this positioning technique.

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Adherence: Adherence is a term used to replace "compliance" in reference to a patient following clinician orders for wound care. Compliance implies that the patient should passively comply with the health care provider’s instructions, whereas adherence allows for patients to have the freedom to follow the provider’s recommendation without blame being focused on them if they do not or are not able to follow these recommendations.

Medical device–related pressure injury (MDRPI): MDPRIs are localized injuries to the skin or underlying tissue resulting from sustained pressure caused by a medical device, such as a brace, splint, cast, respiratory mask or tubing, or feeding tube.

Offloading: Offloading refers to minimizing or removing weight placed on the foot to help prevent and heal ulcers, particularly those caused by poor circulation to the feet due to diabetes.

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Holly Hovan's picture

Holly Hovan MSN, APRN, RN-BC, CWOCN-AP

Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment are two critical components of a strong wound treatment plan and program. Bedside staff members should be comfortable with describing wounds, tissue types, and differentiating wound etiologies. Training should be provided by the certified wound care clinician, along with follow-up (chart reviews and documentation checks, one-on-one education as needed, and routine competency or education days). Additionally, the wound care clinician should be able to develop an appropriate treatment plan based on wound etiology, by involving additional disciplines as needed to best treat the whole patient.

Heidi Cross's picture
Nutrition Management

By Heidi Cross, MSN, RN, FNP-BC, CWON

"Defendants failed to provide adequate nutrition to prevent plaintiff from suffering severe malnutrition and weight loss. This allowed the development of a severe pressure ulcer, numerous infections, and dehydration and malnutrition. Had defendants provided proper care, the pressure ulcer, infections, and malnutrition and dehydration would not have occurred."

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