Pressure Injury Prevention

WoundSource Practice Accelerator's picture

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

In the previous blog, I briefly went through the standards of care when it comes to nutrition and pressure injury (PI) prevention and development and discussed what a large role nutrition plays in PI litigation. Here are several instances: Punitive damages of $92 million, later lowered to $11,855,000, were imposed where malnutrition and dehydration were proven against a nursing home. A dietary manager for a nursing home told state surveyors that her nursing home had "dropped the ball" on a resident's nutrition needs when that resident had lost 17 pounds in 75 days; a $1,385,000 settlement was reached. Malnutrition with a loss of 27% of body weight in 15 months led to a $380,000 settlement just before trial. Shocking, isn't it? It literally "pays" to pay attention to nutrition standards of care.

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By Ivy Razmus, RN, PhD, CWOCN

As we continue to develop our evidence on pediatric pressure injuries, more information has been reported about the risk factors nurses are using for clinical judgment. We know that the newborn skin can vary based on gestational age, and nurses use their clinical judgment frequently when compared with using a pressure injury risk assessment scale. It therefore is important to answer this question: “What are nurses using for clinical judgment for assessing pressure injury risk?”

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mucosal pressure injuries

By Lauren Lazarevski RN, BSN, CWOCN

As I contemplate the current conversation around ventilators, I am encouraged to refresh my knowledge about mucosal pressure injuries. Pressure injuries on the mucous membranes present and are staged differently from cutaneous pressure ulcers, and they are usually attributed to a medical device or tube. Nasogastric or orogastric tubes, oxygen cannulas or masks, endotracheal tubes, and urinary and fecal containment devices pose a risk of causing local ischemia to tissue in the nose, mouth, genitals, or rectum, respectively. Once a mucosal injury occurs, the patient is at increased risk of other problems, including pain, infection (especially if injury occurs to the urinary tract), and even malnutrition, if pain from oral wounds makes it difficult to eat and drink. These hospital-acquired pressure injuries contribute to the physical burden on the patient, as well as the financial burden on the hospital because they do count as a nosocomial—and usually, preventable—ulcer.

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By the WoundSource Editors

The World Health Organization declared COVID-19 a pandemic on March 11, 2020. Whether you are a provider or a frontline health care professional, we are experiencing a worldwide increase in “unavoidable” medical device–related pressure injuries (MDRPIs) during the current COVID-19 pandemic. Health care workers are challenged with a higher risk of pressure injury development secondary to prolonged wear time of the N95 mask, face shield, and goggle personal protective equipment (PPE). The intensity of one or more factors of pressure, moisture, shear, and friction influence pressure injury risk.

WoundSource Practice Accelerator's picture

By the WoundSource Editors

COVID-19: The name of the disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The abbreviation COVID-19 is short for coronavirus disease 2019.

Fit test: A 15- to 20-minute testing of the seal between the respirator's facepiece and your face. After passing a fit test with a respirator, you must use the exact same make, model, style, and size respirator on the job.

Liquid sealant: Liquid skin sealants are designed to protect vulnerable areas from the effects of skin injury. They form a transparent protective coating on the skin. Indicated for use on stage 1 pressure injuries and low-exudating stage 2 pressure ulcers, pressure points and bony prominences, and under adhesive products to protect the skin.

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Nurses' Week

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

With National Nurses Week approaching, we will once again be seeing the work of Florence Nightingale highlighted, along with the concepts and values that have built the nursing profession. As we've heard many times, nursing is an art and a science. The basic foundations and concepts of nursing are built from evidence, books, and what we learn in school from our teachers, professors, and clinical instructors. The science behind nursing is important—there are formulas, math, research, memorizations, and concepts that must come from a book. However, there is also a huge piece of nursing that comes from our hearts. Nursing is caring, compassion, kindness, and wanting what is best for someone else. Nursing is wanting to help our patients and our peers. Being a nurse is a calling and a passion, and that piece can't always be learned... it starts in our hearts, and it shows in our practice.

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Pressure Injury Prevention Carnival

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

Education is key in sustained positive outcomes and it is the first step in understanding pressure injury prevention, for both patients and staff. It's very difficult to hold people accountable for something that they did not know. Therefore, prevention starts with education. For education to be impactful, it should also be fun. Interactive games, small prizes or candy, and engaged and energetic educators are key to fostering an environment where people will remember what they are taught. The teach-back method and continued follow-up and reinforcement are also essential elements of a successful education plan.

Ivy Razmus's picture
Neonatal Pressure Injury Prevention

By Ivy Razmus, RN, PhD, CWOCN

There remain many unanswered questions regarding pressure injury and prevention practices among neonatal patients. Guidelines for pressure injury prevention were initiated in 1992 by the U.S. Agency for Healthcare Research and Quality (AHRQ). Pressure injury prevention practices are based on these guidelines, which recently expanded to include pediatric patients.

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Pressure Injury Prevention

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

Often when we hear the words "pressure injury," our brains are trained to think about staging the wound, considering treatment options, and obtaining a provider's order for care. Ideally, when we hear the words "pressure injury," we should think prevention! As Benjamin Franklin once said, "an ounce of prevention is worth a pound of cure." This is a very true statement and speaks volumes to our goals of care and education format when developing pressure injury prevention curriculum for our facilities.