Pressure Injuries—the sensitive indicator

N. Dhana Sekaran

Manager, Clinical Governance, Kauvery Group of Hospitals

Definition

Pressure injuries are caused by something putting pressure on or rubbing your skin. It can happen to anyone, but it is usually if you have problem in moving, as this can mean the weight of your body is always putting pressure on the same areas of skin, which can damage it.

Risk

People most at risk are those with a condition that limits their ability to change positions. Bedsores often develop on the heels, ankles, hips and tailbone. They can develop quickly.

Pressure Injuries are caused by three factors

  1. Prolonged pressure over bone prominence, which leads to tissue ischemia and necrosis.
  2. A combination of shear and friction, when the patient is lying in bed, leading to capillary damage and local hypoxia and
  3. Prolonged moisture, which leads to maceration and tissue distraction.[1]

How does it occur?

A pressure sore is a lesion that develops on the skin and underlying tissues due to unrelieved pressure usually over a bony prominence. The skin and tissues rely on an adequate blood supply for oxygen and nutrients. When tissues are compressed for an extended period from hours to days, blood supply can be cut off, leading to development of a sore.

What shall we do?

The Joint Commission International (JCI) has given a specified formula to identify the sensitive indicator, incidence of pressure injury, which is considered as the act of negligence by the entire health care team.

Number of patients who develop new/worsening of pressure injury in a given month

Number of discharges and deaths in that month

Though it has been supported by many studies that the entire team (doctors, nurses, physiotherapist and dietician) is responsible if a patient develops pressure ulcer but it largely falls on the shoulders of nursing team. It is essential for the health care members to assess the risk of developing pressure injury for the patient upon admission to the hospital. [2]

Assessment is the key to prevention for most of the outcome-based quality indicators. Braden scale is reliable and popular scale used in healthcare setting to assess the risk of pressure ulcer as development of pressure ulcer is affected by many factors.

Management on Clinical Governance perspective

Every health care set up must have CG functional for effective care and quality. The management is broadly adopted and modified from the International Prevention and Treatment of Pressure Injuries: Clinical Practice Guideline – 2019. It has three main components in it; they are the comprehensive strategical approach, evidence-based approaches and systematization.

The Comprehensive Care Standard requirements

  • Systems are in place to support clinicians to deliver comprehensive care
  • Integrated screening and assessment processes are used in collaboration with patients, carers and families to develop a goal-directed, comprehensive care plan
  • Safe care is delivered based on the comprehensive care plan, in partnership with patients, carers and family, including patients who are at the end of life
  • Patients at risk of specific harm are identified, and clinicians deliver targeted strategies to prevent and manage harm.

Evidence-based approaches to pressure injury prevention and management include

  • Timely identification of risk factors
  • A standardized and documented risk screening process to identify if an individual is at risk of developing a pressure injury and guide clinical decision making
  • Regular skin assessment for individuals with identified risk factors
  • Communication of identified risk
  • Engaging with patients and their carers in a culturally sensitive manner
  • Developing, implementing and reviewing of a plan of care that is;
    • Tailored to the individual’s goal of care, preferences and addresses their risk factors
    • Focused on prevention and wound healing if a pressure injury is present
    • Comprehensive and interdisciplinary
    • Delivered by staff with appropriate knowledge and skills who use evidence-based prevention and management strategies and resources
    • Inclusive of access to appropriate products and equipment

Systems to monitor

A well planned and highly communicated systems are to be in place with periodic monitoring.

  • All appropriate prevention strategies are consistently implemented to reduce the risk
  • Pressure Injury Prevention and Management resources are available. [3]

The Nursing excellence and the quality of care rendered by the hospital is indirectly proportionate to the hospital acquired pressure injury. Hence, it is necessary for all the health care team members to work with uncompromising motive.

“Zero Tolerance to Pressure Injury” @ Kauvery Groups!!!

Reference


N. Dhana Sekaran
Manager Clinical Governance

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