Pressure Injuries

Heidi Cross's picture

Since the advent of coronavirus disease 2019 (COVID-19), I haven’t done much flying, but I love travel and I love flying. One of my favorite experiences is a window seat at about 30,000 feet on a clear sunny day. The views can be spectacular – whether flying across the Rockies or the Plains or any of the stunning and varied scenery of this country or the world. A couple of my most memorable flights involved flying into New York City with views of the New York skyline with Lady Liberty in clear sight, or into Washington, DC with clear views of the Mall, the Jefferson Monument, and the Capitol. The Alps and the Rockies are incredibly awe-inspiring, beautiful, and breathtaking. From there, you get a good overall picture of the landscape.

WoundSource Practice Accelerator's picture

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 socioeconomic cost of chronic wounds is 2% to 4% of the health budget in Western countries. Moreover, patient mortality in individuals with chronic wounds has been estimated at 28% over a two-year period, significantly higher than the 4% mortality rate reported for 75 to 79 year-olds without chronic wounds.

WoundSource Practice Accelerator's picture

Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that recurrence rates are high; nearly 40% of patients with an ulcer will develop a recurrence within one year of healing. This percentage is 60% at three years after healing and 65% at the five-year mark.

Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

Hard-to-heal wounds, such as diabetic foot ulcers, pressure injuries, and venous leg ulcers, comprise a significant portion of health care visits, and these wounds place a physical and economic burden on many patients. These hard-to-heal wounds are defined as wounds with stagnant or delayed stages of healing that fail to resolve within eight weeks. Finding ways to accelerate this healing process is of great importance because it can reduce the physical and economic burden on patients, as well as decreasing costs for health care facilities. Matrix metalloproteinases (MMPs) are endopeptidases, which are involved in many healing processes, including the cell signaling processes, migration processes, angiogenesis, and the degradation of extracellular proteins. These mechanisms are necessary for the wound healing process by breaking down damaged tissue. In the late stages of healing, when breaking down of tissue is no longer necessary, tissue inhibitors of metalloproteinases down-regulate MMPs. In hard-to-heal wounds, this process is thrown off balance, with delays in the subsequent stages of healing. In an attempt to restore this balance, MMPs have been investigated for their role in wound healing through MMP-inhibiting wound dressings. There have been a number of consequential reviews done using current market wound dressings, such as oxidized regenerated cellulose/collagen and Technology Lipido-Colloid with nano-oligosaccharide factor (TLC-NOSF).

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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WoundSource Practice Accelerator's picture

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.