Pressure Injury Prevention

by the National Pressure Ulcer Advisory Panel

Washington, DC – April 12, 2019 – On March 25-27, Dr. William Padula visited Washington, D.C. to advocate for policy solutions surrounding pressure injury prevention at the highest levels of government and health care. His independent advocacy for improving patient safety was provided as a researcher on behalf of NPUAP and its panel members. Dr. Padula is Treasurer on the Board of Directors for NPUAP, as well as an Assistant Professor of Health Economics at the University of Southern California Schaeffer Center for Health Policy & Economics in Los Angeles, along with a secondary appointment at the Johns Hopkins School of Nursing in Baltimore.

By Ivy Razmus, RN, PhD, CWOCN

The very old and the very young are more alike than you might think when you consider risk for skin injuries. They are alike regarding their limited sensory perception, mobility, and activity. They are also alike in their potential for inadequate nutrition and their skin's supporting structures (muscle, collagen and elastin). These similarities place them at greater risk for pressure injuries.

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

So, you’ve selected the support surface that is perfect for the resident. What’s next? Next steps: education, utilization, reassessment, and repeat. So many questions! Remember, as I have said before, nothing here is common sense, only common knowledge. It is your responsibility to make sure the staff left in charge of the direct care of residents has that knowledge. Think basics!

by the WoundSource Editors

Those working with at-risk populations must be aware of how to address the skin care needs of our patients and prevent pressure ulcers and injuries. At-risk populations, such as older adults, persons who are incontinent, pediatric patients, immobile patients, post-operative patients, and those with chronic disease processes and spinal injuries, for example, are most at risk for developing pressure ulcers. Those patients who have comorbidities such as obesity, diabetes, and cardiovascular disease are at additional risk.

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

Recently, one of my awesome staff nurses coined a phrase that stuck with me—Mr. DoctoR Pressure Injury (MDRPI), also known as medical device-related pressure injury. MDRPIs are a common yet usually preventable problem. We wanted to raise awareness of MDRPIs for World Wide Pressure Injury Prevention Day in November of 2018, and one of our staff nurses was quite creative in doing so! She thought of using a doctor’s briefcase with medical devices inside, many of which can and do cause pressure injuries. Being creative and using acronyms are great ways not only to engage staff, but also to be sure that they remember the information provided to them. Additionally, hands-on props and interactive stations require engagement, which appeals to many different types of learners.

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

"If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed sore, it is generally the fault not of the disease, but of the nursing." —Florence Nightingale

Ouch! What an indictment of nursing and, by extension, the facility in which the nurse works. We have a lot to thank Florence Nightingale for—a brilliant woman considered to be the founder of nursing and nursing standards and the first to ever put statistics to health care, among other valuable contributions.

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

When looking at medical charts from a legal perspective, one of the areas closely scrutinized is the risk assessment for skin breakdown and pressure ulcer development. Completing a risk assessment is considered a standard of care. Was the patient adequately assessed, and was this done in a timely fashion? Was it repeated at regular intervals, with a change in condition, or on readmission? Do scores seem appropriate for the patient's condition? Is there consistency among health practitioners? Were the results used to institute evidence-based and appropriate prevention and treatment measures and care plans? Or do the results seem to simply languish in the chart? What are the standards of care related to this?

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

What does your facility do to raise awareness regarding pressure injury prevention? We have lots of educational opportunities throughout the year, but one of our most important and prepared for days is the third Thursday in November – World Wide Pressure Injury Prevention Day! This is a day to raise awareness that has been promoted by the National Pressure Ulcer Advisory Panel (NPUAP). Every year, the NPUAP puts out a press release and lots of good information in terms of ways to educate and engage staff on such an important topic, on a national level.

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

Failure to T&P (turn and position) is always part and parcel of a pressure ulcer lawsuit and a key element of a complaint related to pressure ulcers, as illustrated in the opening quotation. T&P documentation is a dominant focus in chart analysis and is usually one of the first things that an attorney and the expert witness look for. If T&P documentation is satisfactory, the defendant is likely to prevail; if not, then the plaintiff may have a pretty rock-solid case. But as I have opined in previous blogs, is there such a thing as perfect documentation? Alas...NO! (Or at least, rarely.)

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).