According to a recent study in the Archives of Physical Medicine and Rehabilitation, the occurrence and severity of pressure injuries upon admission to an inpatient rehabilitation hospital increased by roughly 15% during the early days of the COVID-19 pandemic.
Pressure injuries are painful lesions on the skin that develop due to pressure from lying in bed or being attached to medical devices. These injuries can have significant repercussions for both patients and hospitals, including a longer hospital stay, worse patient care outcomes, and increased cost of care. For example, these types of wounds also account for approximately $10 billion in annual health care spending in the U.S every year.
“Every intervention a medical team does or doesn’t do either propels a patient forward in their recovery or delays it,” Diane Ulmer, the spinal cord injury program manager at Madonna Rehabilitation Hospitals, said. “Implementing structured plans for wound prevention upon admission will result in a decreased burden of care, decreased length of stay, and ultimately, get the patient to rehab sooner for the best possible outcome.”
However, Ulmer acknowledged that the current rise of pressure injuries is most likely a result of the challenges many health care organizations have endured as the pandemic continues.
“Following best practices is a challenge in our current health care environment,” Ulmer said. “That is why it is more important than ever to work as a team and utilize the best equipment and technology to help us keep our patients safe.”
Below, you’ll find Ulmer’s recommendations for pressure injury prevention methods.
Establish an action plan: During this challenging time, protocols and processes can help teams be more efficient. To help prevent pressure wounds among high-risk patients, some acute care teams have implemented a specialized “turn team” with dedicated staff to make sure repositioning and early mobilization occur. When that’s not possible, Ulmer recommends the use of technology. “Other teams may implement individualized repositioning schedules with reminders in the electronic medical record or utilize other alarms to ensure repositioning and skin checks are completed in a timely manner,” Ulmer said.
Use proper equipment as needed: Ensuring high-risk patients are placed on proper pressure-relieving support surfaces as well as having protocols in place to address incontinence are prevention strategies that can help a great deal in wound prevention. Lifts, friction reduction sheets, repositioning sheets and devices such as the air tap can also be excellent assets. Additionally, a team could enlist the help of a patient’s loved ones. “The use of tilt in space wheelchairs with pressure-relieving cushions is one easy way to ensure a patient can get pressure relief every 15 minutes because then even family can be trained and engaged in the process of prevention,” Ulmer explained.
Remember nutrition: A healthy diet fuels recovery and can help prevent wounds. However, recent research suggests that up to an estimated 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, alternated immune function, and impaired skin integrity and wound healing. Ulmer suggests developing an individualized nutrition plan for at-risk patients with a registered dietician and working toward safe oral intake as soon as possible.
Keep skincare top of mind: Wet or dirty skin breaks down faster so ensuring a proper bowel and bladder program is in place will decrease the burden on the staff and help keep skin healthy, Ulmer noted. Completing a skin check at least twice a day or with each repositioning allows for quick action to be taken when an area of pressure is identified. Ulmer added that avoiding a secondary complication such as a wound increases the chances of a positive patient outcome in the long run.
“You need good skin to tolerate travel and experience new adventures, to sit at a child’s soccer tournament all day, to return to work or participate in adaptive sports,” Ulmer said. “The acute care team is vital to the patient’s long-term success following a traumatic injury or illness, and their hard work and attention put the patient on a trajectory of a quicker return to their independence and life roles.”
To learn more about pressure injury prevention, please consider the following resources:
- 2019 International Clinical Practice Guidelines from the National Pressure Injury Advisory PanelPressure Ulcer Prevention and Treatment Following Spinal
- Cord Injury: Clinical Practice Guideline for Health Care Professionals
Citty, S. et al (2019). Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv. Wound Care. Jul 1; 8(7):309-322
Cullen Gill, Emma. (2015) BMJ Qual Improv Rep. Published Online June 8
Goiburu, M. E, et al (2006) The impact of malnutrition on morbidity, mortality, and length of hospital stay in trauma patients. Nutr Hosp. Sept-Oct 2006;21(5):604-10