Pressure Injury

Dianne Rudolph's picture

Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, UTHSCSA

Dealing with patients who can’t or won’t participate in their care can be a challenge for health care providers across all settings. In wound care, this lack of participation can result in great financial costs, diminished quality of life, and suboptimal clinical outcomes. This is part 2 of a 2-part series on noncompliance in wound care patients. Part 1 addressed possible reasons for noncompliance. In part 2, strategies to address these issues and increase patient participation are discussed.
Part 1 of this blog discussed factors that impact a patient’s ability to adhere to clinician recommendations for care. Consequently, the most appropriate term to use when dealing with patients facing these obstacles is nonadherence. This term tends to be less value laden and more objective than noncompliance. Some of the reasons for nonadherence are voluntary and some are involuntary, or beyond the patient’s control. To review briefly, these reasons may include gaps in knowledge about the implications or severity of a chronic wound, limited recommendations or education by clinicians, perceived disadvantages to treatment, psychological factors, cultural factors, and social or financial constraints. Additionally, in some cases, alcohol or drug dependence can impact the patient’s ability to participate fully in their care.

Heidi Cross's picture

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

The United States is one of the most litigious nations in the world, with the result that numerous medical malpractice lawsuits are initiated against hospitals and other health care facilities, as well as practitioners. Commonly, these lawsuits allege that the facility failed to meet standards of care related to management of wounds including pressure injuries, failed to provide adequate nutrition, and did not properly address issues such as incontinence.

Alex M. Aningalan's picture

Alex M. Aningalan, MSN, RN, CWON, WCC

Chronic wound conditions are prevalent across health care systems globally and often result in economic and humanistic burdens on clinicians and patients.1 Moreover, pressure injuries, among of the more common types of chronic wounds, affect an estimated 2.5 million people in the United States annually, resulting in a staggering 60,000 preventable deaths.2 In addition, the Centers for Medicare & Medicaid Service reported that the United States spends about $9.1 to $11.6 billion annually as payment for the burden imposed by pressure injuries.2

Holly Hovan's picture

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

Moisture-associated skin damage (MASD) is becoming increasingly prevalent in today’s health care system. Often associated with discomfort and pain, MASD ultimately negatively impacts quality of life. MASD is usually broken down into 3 or 4 categories, most commonly incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound dermatitis, and peristomal dermatitis. In this blog, I focus on the prevention and treatment of IAD and subsequent pressure injuries in critical care through a nurse-led approach.

Heidi Cross's picture

I have been there, done that. Sitting in the fact witness chair in front of a plaintiff attorney who is wildly waving a copy of my facility’s wound care policy and procedure, demanding to know why certain things weren’t included in the policy, and why what was in the policy was not followed to the letter. Plaintiff attorneys have the right to demand copies of a facility’s policy and procedures as part of discovery and will go through them with a fine-tooth comb, compare what is in the policy with the care that was provided, and fault the facility for any deviations. It goes without saying that I promptly returned to my facility with a new understanding for how our policy was written and possible gaps and weaknesses.

Robin Lenz and Fahad Hussain's picture

By Dr. Lenz and Dr. Hussain

For the patient, the prevention of sores and injuries is better than treating them. Pressure-relieving mattresses may be essential for preventing pressure injuries (bed sores). These mattresses aid in relieving and redistributing pressure and can thereby cause a reduction of friction and shearing. Pressure-relieving mattresses provide support for the body and reduce the amount of force applied to a given area. Thus, for bedbound patients and patients who are unable to reposition themselves, these types of beds can be especially beneficial.

Robin Lenz and Fahad Hussain's picture

By Dr. Lenz and Dr. Hussain

Heel pressure injuries and various forms of ulcers are easy to identify, but are you overlooking sleeping position as a cause for wounds in other locations? Do you have a wound you are sure is venous but has normal venous insufficiency testing results and fails to respond to compression? Can pressure while sleeping slow or stop healing in your patients with venous and arterial wounds? Do you ask patients about their sleeping position in your history taking and physical examination? After reading this article, you will be able to ask patients about their sleeping habits and heal more wounds with that knowledge

Margaret Heale's picture

By Margaret Heale, RN, MSc, CWOCN

Medical device–related pressure injuries (MDRPIs) are recognized as a significant problem, evidenced by the inclusion in the National Pressure Injury Advisory Panel pressure injury definitions and described by Pitman and Gillespie in 2020.1 Prevention of medical device-related pressure injuries is a goal that may be achieved through meticulous patient care.

Holly Hovan's picture

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

Pressure injuries (PIs) typically are the result of unrelieved pressure, shear, or force. In an inpatient or hospital setting, interventions are put into place to prevent pressure injuries based on evidence and patient risk. However, PIs still develop in some patients despite interventions. Experts agree that most PIs are in fact avoidable; however, some patients may experience unavoidable skin breakdown at end of life (EoL).¹ Kennedy terminal ulcers (KTUs), skin changes at life’s end (SCALE), and Trombley-Brennan terminal tissue injuries (TB-TTIs) are some of the common terms used to describe unavoidable skin changes at EoL.¹

WoundSource Editors's picture

By WoundSource Editors

Pressure injuries are common among patients who experience extended exposure to pressure on a bony prominence or shear to areas of poor turgor, two factors that lead to constriction of a patient’s blood supply to the exposed area. A patient who is bedridden or has certain chronic conditions, such as diabetes, is more likely to develop a pressure injury. When mechanical force is imposed on the skin, it can result in poor blood flow and damage to the bone-muscle interface, thus making tissue sensitive and painful. For patients with limited mobility, this can be especially frustrating because they may not be able to adjust positions or medical equipment. If pressure injuries are left untreated or unnoticed, they can also become infected and even enter muscle and bone. Risk assessment tools are available to assess pressure injury risk and can work in tandem with practice standardization, thereby leading to effective treatment plans for practitioners and patients.

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