Improving Pressure injury (PI) Prevention and Management
Pressure injuries (PIs) affect patients worldwide, with significant implications for healthcare workers. PIs acquired or exacerbated at any point during the hospital stay are commonly referred to as hospital-acquired pressure injury (HAPI) and reported as indicators of quality of care. As a common yet dangerous hospital-acquired complication, understanding how healthcare workers learn and implement evidence-based practice in the detection of PIs is critical.
Comprehensive skin assessments are crucial for evaluating pressure injuries. The staging of pressure injuries should follow the updated staging system of the National Pressure Injury Advisory Panel. Risk assessments allow for appropriate prevention and care planning, and physicians should use a structured, repeatable approach.
Prevention of pressure injuries focuses on assessing and improving nutritional status, repositioning the patient, and providing proper support surfaces. Treatment involves pressure off-loading, nutritional optimization, proper bandage choice, and wound site management. Pressure injuries and surrounding areas should be cleaned, with additional debridement of devitalized tissue and biofilm if necessary. All injuries should be checked for local infection, biofilms, and osteomyelitis. Appropriate wound dressings should be selected based on the injury stage and the quality and volume of exudate.
Pressure injuries are focal damage to skin, underlying tissue, or mucous membranes resulting from pressure that is intense, prolonged, or both. The combination of pressure and shear forces can also cause pressure injuries. Bony prominences are common sites for pressure injuries. These injuries can also be related to medical devices or other objects that contact the patient's skin.
Pressure injury prevention checklist includes the following steps per American Academy of Family Physicians:
- Assess and improve nutritional status
- Reposition the patient
- Provide proper support surfaces
- Implement measures to prevent perioperative pressure injuries in surgical patients
- Reduce, relieve, and redistribute pressure
- Prevent shear
The pressure ulcer bundle concept incorporates three critical components in preventing pressure ulcers per the Agency of Healthcare Research and Quality (AHRQ)
- Comprehensive skin assessment. Inspection and palpation are key.
- Standardized pressure ulcer risk assessment- determines which patients are more likely to develop a pressure ulcer, particularly if no special preventive interventions are used to identify distinct levels of risk. According to AHRQ, two risk assessment scales that are widely used in the general adult population: the Norton Scale and the Braden Scale. Both the Norton and Braden scales have proven reliability and validity.
- Care planning and implementation to address areas of risk. This includes planning for any risks found on the risk assessment tool, such as nutrition, activity, mobility, moisture, and friction/shear, as well as any other risk factors.
- Take an integrated approach
- Ensure continuity of care by all staff members
- Incorporate the patient's response to the interventions and any changes in their condition.
- Coverage benefits for DME, such as, adjustable/extended beds and select cushions or mattresses, please contact provider services to identify if the DME is a covered benefit or if a prior authorization is needed.
References:
Pressure Injuries: Prevention, Evalutation, and Management - American Academy of Family Physicians
Preventing Pressure Ulcers in Hospitals - Agency for Healthcare Research and Quality