PRESSURE INJURIES

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As you can see above , November 16 is 2017 Worldwide Pressure Injury Prevention Day.

This is an initiative of the USA National Pressure Ulcer Advisory Panel (NPUAP).

It’s purpose is to increase awareness for pressure injury prevention and public education.

Since Florence Nightingale, pressure injuries have been a nursing concern.

The modern term is pressure injuries.

Previously, the terms used to describe the same concern has been bedsores, pressure sore, decubiti, and pressure ulcers.

Pressure injury is replacing these other terms as it has been identified that pressure injuries may be present even when there is intact skin.

The term ‘pressure injury’ does not imply causation by a health care provider.

The NPAUP clarified the term in a position statement where they said

The diagnosis of a “pressure injury” does not mean that the health care provider “caused” the injury”’

They also stated that

‘“Pressure injury”is a more accurate label than “pressure ulcer” because some presentations of the phenomena are not open ulcers: yet all can be legitimately classed as tissue injuries.

Using the term “pressure injury” places the emphasis upon prevention .

Falls and other injuries can often be prevented.

But ulcers are often part of a larger pathological process such as venous ulcers or diabetic foot ulcers.

To refresh, pressure injuries result from pressure or a combination of shear forces and pressure.

Other factors that come into play with pressure injuries are nutrition, perfusion, microclimate, co-morbidities as well as the condition of soft tissue.

Over 20% of a sample of patients have been identified with a pressure injury.

And a patient who used a medical device were found to be 2.4 times more likely to develop a pressure injury than patients who did not use a medical device.

In this a context, a medical device may be a oxygen nasal cannula, pulse oximeter, endotracheal tubes, indwelling urinary catheters, intravenous cannula, nasogastric tubes, neck collars, traction equipment, blood pressure cuffs…

In short, any medical equipment.

But it is not only medical equipment that can cause pressure injuries – it is a rare nurse that has not removed from a bed combs, toothbrushes, eye glasses, toiletries, cutlery, various meal items, hearing aids, call bells, phones etc.

All of these items are potential sources of pressure injuries.

A mnemonic is a system such as a pattern of letters, ideas or associations that assist in remembering something.

DEVICE is a  mnemonic that has been devised to assist recollection about the prevention and treatment of medical device-related pressure injuries.

D stands for DETERMINE that all medical devices are commercially manufactured for use in the clinical setting (not homemade) and can be placed without making contact with prior or existing pressure injuries.

E is for EVALUATE all devices, every skin-device interface, and the surrounding skin as least twice daily, and more often in patients with localised or generalized oedema.

V stands for VERIFY that nursing staff have been taught how to correctly use and secure medical devices and understand that mucosal medical device-related pressure injuries must be counted and tracked separately from skin pressure injuries.

I is for IDENTIFY all medical devices on all patients, especially those most vulnerable to medical device-related injuries; critically ill patients, neonates, children, older adults, and bariatric patients.

C stands for CONSIDER the following any time medical devices are in use: Does the patient still require use of the device – can it rotated, repositioned, replaced or removed? Is the fit correct? Can a prophylactic dressing be used beneath devices placed in high-risk areas (the nasal bridge, for example)?

E is for EDUCATE all staff to look for objects that might be in the bed or chair under the patient.

Between 2006 and 2015, the prevalence of pressure injuries in the US dropped by over half from 6.4 to 2.9%.

The goal of pressure injuries should be zero.

But even NPUAP concedes that due to aetiology, risk factors, differential diagnoses, and the natural evolution of deep tissue pressure injury, that some patients may evolve into a full thickness wound despite optimal care.

Pressure injuries may occur rapidly or may resolve without tissue loss, as nurses have been observing since Nightingale.

To learn more about pressure injuries:

2017 World Wide Pressure Injury Prevention Day

NPUAP Position Statement on Staging – 2017 Clarifications

Pressure Injuries Caused by Medical Devices and Other Objects: A Clinical Update by B. Delmore and E. Ayello 2017