Pressure Injury Prevention

Margaret Heale's picture
Details

By Margaret Heale, RN, MSc, CWOCN

In our point, click, fill-in-the -blanks world of ever increasing wound care algorithms and MOs, I have an ax to grind (straight into my so-called smart phone if I had the courage).

Where is the detail? Pronouncing sweeping statements such as 'Q 2 hourly turns' is easy. Ensuring a person is repositioned at a time that is prescheduled, that fits in with meal times, a self-catheterization schedule, OT, PT, and doctors' visits while taking into account that the patient would like to feel in control and watch the baseball game is, no doubt, less straightforward. That is only the beginning of the necessary detail we need to have documented for our wound patients. Please bear with me while I go into the microscopic level of the sweeping statement for a spinal injury patient because actually doing is much less straightforward in implementing a pressure injury prevention plan.

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Holly Hovan's picture
Interdisciplinary Journal Club

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

Wound, ostomy, continence (WOC) nurses wear many hats. A significant role that we play is that of an educator, both with our patients and with our staff. I'm sure we've all heard "How on earth did you ever get interested in wounds? What made you want to be a wound specialist?" or similar comments. There are so many specialties in nursing, so why this one? For me, it is about helping others.

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WoundSource Practice Accelerator's picture
Repositioning tool

by the WoundSource Editors

In today's health care market, we have numerous turning and repositioning tools, offloading devices, and sensor technology gadgets available. You may ask "Why do we need any of these technologies if we provide consistent quality of care?" "Consistent" is the key word in preventing ALL pressure injuries/ulcers. There are nursing shortages, gaps in education, and a need for nursing or caregiver efficiency.

There will always be a risk of pressure injury/ulcer development for our sick patients. If we can use advanced technology to promote "consistent" quality of care, we should do it. However, in our health care system, the battle for reimbursement drives what equipment we can use for our patients. We need to compare and assess the available options before selecting what enhanced prevention tools or devices we may want to utilize.

Susan Cleveland's picture
Support Surfaces for Special Populations

By Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

Certain patient populations—such as the critically ill, those with spinal cord-injuries, and bariatric individuals—need special interventions and support surfaces to prevent pressure ulcers. These recommendations address the unique needs of these special populations in relation to pressure redistribution, shear reduction, and microclimate control.

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Susan Cleveland's picture
Support Surfaces

By Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

On occasion there are Administrators or a Director of Nursing who are amazed (not surprised) that despite their use of pressure-“relieving” mattresses and chair cushions, their facility is still experiencing in-house acquired pressure ulcers. Of course, a teaching moment presents itself, and the lesson begins. The items referred to are going to “redistribute” pressure, not relieve it, so there is either a lack of understanding or a misuse of terminology, and clarification is necessary

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Janet Wolfson's picture

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.

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Nancy Munoz's picture
Nutrition and Protein

by Nancy Munoz, DCN, MHA, RDN, FAND

The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury as localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can manifest as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure, occasionally in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and the condition of the soft tissue.

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Holly Hovan's picture
patient mobility and activity

By Holly Hovan MSN, APRN, CWOCN-AP

The Braden category of activity focuses on how much (or how little) the resident can move independently. A resident can score from 1 to 4 in this category, 1 being bedfast and 4 being no real limitations. It is important to keep in mind that residents who are chairfast or bedfast are almost always at risk for skin breakdown.

Holly Hovan's picture
enteral nutrition feeding

By Holly Hovan MSN, APRN, CWOCN-AP

A common misconception by nurses is sometimes predicting nutritional status based on a resident's weight. Weight is not always a good predictor of nutritional status. Nutritional status is determined by many factors and by looking at the big picture.

WoundSource Practice Accelerator's picture
pressure injury risk assessment

by the WoundSource Editors

Pressure ulcers/injuries pose a major risk to patients by increasing morbidity and mortality and causing significant discomfort.1 They are also prevalent, particularly in long-term care facilities, where patient populations may be at higher risk of developing pressure injuries as a result of factors of age, immobility, and comorbidities.2 To reduce the incidence of pressure injuries effectively, nurses and other health care professionals should be aware of the risk factors and the means to evaluate patients. This will allow caregivers to take steps to prevent problems before they develop and treat them more effectively if they do.