Pressure Redistribution

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According to the National Pressure Injury Advisory Panel (NPIAP) definition, “A pressure injury is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.” Pressure injuries are an unfortunate and all too frequent occurrence, despite being preventable. It is estimated that approximately 2.5 million hospitalizations in the United States are due to pressure injuries. According to research by the NPIAP, up to 40% of patients will develop a pressure injury while in critical care units. However, a clinician can assist in preventing these pressure injuries by understanding which anatomic areas are most at risk.

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By Shannon Solley, Assistant Editor, WoundSource

Is there an irremovable offloading device suitable for lower extremity pressure injuries? “An irremovable heel offloading device encourages increased compliance,” says Dr. Lenz and Dr. Hussain within their poster presentation at SAWC, “Heel Offloading Posterior Splint for Treatments of Heel Ulcerations.” However, most total contact casting (TCC) proves a greater risk of injury through iatrogenic complications and possible increases in pressure. Dr. Lenz and Dr. Hussain present the use of a particular posterior splint application method that may resolve possible complications traditional splints pose.

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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.

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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

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Advanced Therapies for Diabetic Foot Ulcers

By the WoundSource Editors

Advanced wound care technologies have come a long way in treating chronic wounds. However, diabetic foot ulcers (DFUs) can be challenging, and not every patient should have identical treatment. Utilizing a patient-centered approach is necessary for selecting appropriate treatments and achieving best possible outcomes. Understanding the specific patient’s needs and understanding the pathophysiology of diabetic wound chronicity are key elements in DFU management. The primary goal should be wound closure, while also preventing recurrence. To achieve both goals, clinicians must incorporate ongoing education and clinical support. Health care professionals should keep up on latest evidence-based research and practices to select the best advanced treatment for each patient.

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Frequently Asked Questions

By Kara S. Couch, MS, CRNP, CWCN-AP

Hospital-acquired pressure ulcers (HAPUs) pose a challenge for acute and post-acute care environments and are listed as hospital-acquired conditions (HACs) by the Centers for Medicare & Medicaid Services (CMS). Other HACs include central line–associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Although CLABSIs and CAUTIs have seen a decrease in prevalence over the past decade, the HAPU is the only HAC that has not. In my recent WoundSource webinar, I discussed the topic of building a pressure ulcer prevention program within hospitals. The webinar is still available for viewing on WoundSource.com.

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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.

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Worldwide Pressure Ulcer/Injury Prevention & Awareness Day

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

Worldwide Pressure Ulcer/Injury Prevention & Awareness Day is November 21st. This day is considered pretty much a holiday at my home. I have Stop Pressure Ulcer tee shirts, and I order a cake or STOP sign cookies every year from the bakery in memory of my mother. To some it might sound crazy, but my life was strongly impacted forever in 1996 after my mother passed away in my arms at only 47 years old because of complications of diabetes and what was called at that time "multiple decubitus." The image and smell will never leave my mind. It changed my life forever as a daughter, a caregiver, and later as a wound nurse. I needed more answers to heal my heart. How could my mother acquire such horrible wounds while at the hospital to get better? My mind was twirling nonstop with the 5Ws. Who, what, when, where, why? So, then it began. I wanted to learn everything I could. This ended up being sort of my therapy, which transitioned into my passion and purpose.

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End of Life Skin

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

Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

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Risk Assessment Standardization

By the WoundSource Editors

The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. When utilized on a regular basis, standardized assessment tools, along with consistent documentation, increase accuracy of pressure injury risk assessment, subsequently improving patient outcomes. Conversely, inconsistent and non-standardized assessment and poor documentation can contribute to negative patient outcomes, denial of reimbursement, and possibly wound-related litigation.