The Joint Commission & healthcare systems nationwide heighten the importance of reducing pressure injuries

Once known as bedsores, skin ulcers acquired by hospital patients are now called pressure injuries. The renewed attention around these dangerous wounds is not in name only; The Joint Commission, along with hospitals across the United States, are working to better identify triggers and refine best practices to reduce pressure injuries.

An avoidable issue

According to The Joint Commission, an estimated 2.5 million acute care patients in the U.S. experience pressure injuries each year, leading to longer hospital stays, multiple readmissions and more than 60,000 deaths. Diagnosed by clinical exam, hospital-acquired pressure injuries (HAPIs) commonly occur from pressure on the tailbone or hips, heels, shoulder blades, the back of the head, the backs and sides of knees, and the sides of the ankles.

Renamed about five years ago to reflect the active role clinicians can take in preventing and treating these soft tissue ulcers, HAPIs are designated by the Centers for Medicare & Medicaid Services as “never events”—medical errors that should never occur.

Jessica Corso, BSN, RN, CWOCN

According to Jessica Corso, BSN, RN, CWOCN, Category Program Director for Ambulatory and Acute Care, Supply Chain at Franciscan Alliance, in Lafayette, Indiana, both intrinsic and extrinsic factors play a role in the development and the worsening of pressure injuries. These include age, weight, incontinence, mobility, circulation, sensation and poor nutrition, as well as other comorbidities that might cause a patient to have a dulled sense of pain or pressure.

“Pressure injuries can happen within a couple of hours,” Corso explains. “When a patient comes to one of our ERs, nursing staff complete an assessment and start offloading and turning regimens for patients with signs and symptoms of impaired skin integrity or existing wounds. Pain control may be necessary for the patient’s tolerance of movement and position change. Then we worry about all the other parts of the body they’re using to move, such as the tailbone, elbows, heels and scapula. It’s beyond the area we know is compromised—it’s all their skin surface areas that endure shearing and friction that require protection.”

Tackling the problem

The Joint Commission’s quality improvement arm, the Center for Transforming Healthcare, launched an ambitious project that led to a 62% drop in HAPIs between 2018 and 2020. These results—remarkable considering they occurred amid the COVID-19 pandemic—were tallied among three collaborating institutions: Johns Hopkins, Kaiser Permanente South Sacramento and Hermann Southeast hospitals.

All hospitals participating in The Joint Commission initiative identified their unique contributing factors to HAPIs, achieving an average 55% relative drop in intensive care pressure injuries in the project’s first 18 months and building on that success despite the challenges of the COVID-19 pandemic.

This prominent effort reflects widespread, national interest in fighting pressure injuries by identifying their root causes, acquiring the latest clinical products and implementing standardized protocols, says Corso.

“HAPIs have always been a problem. The current state of healthcare, with a pandemic and a staffing shortage at so many hospitals, makes it that much more so,” Corso explains. “Typically, the patient suffering from a pressure injury is one who can’t turn themselves, so you really need all hands on deck,” she adds, noting that only about 8,000 wound care-certified specialists work across the U.S., placing a bigger burden on staff members without this specialized training.

Innovative products

Indeed, frequently repositioning immobilized patients is the primary tactic clinicians have long used to prevent and reduce pressure injuries. These injuries can occur whether patients are lying in bed, sitting in a wheelchair or even wearing a cast for a lengthy period.

“If you’re boosting people up in bed and do not achieve clearance of their body, and the surface friction and shearing occurs, this can cause a wound or worsening of an existing wound,” Corso explains. “It’s kind of like a carpet burn on the surface and intense tissue separation down at the bone level.”

Fortunately, an increasing variety of products have been developed to boost these efforts by either removing pressure on affected areas, protecting wounds or averting infection. These products include low-air-loss mattresses—which contain air tubes that alternately inflate and deflate, simulating a patient being repositioned—as well as barrier films and moisture-wicking bandages. Corso says these specialized paddings and surfaces can prevent friction and keep skin cool and dry.

Using evidence-based research, Franciscan Alliance’s “Pressure Injuries Playbook” adheres to an ambitious goal: Patients arriving at the hospital with no skin issues should not develop any during their stay, while those with existing pressure injuries should be maintained or treated to help resolve them.

In addition to using innovative products, taking common-sense measures such as changing patients’ gowns, wiping down moist skin or providing moisture where needed can all help to ensure the integrity of the patient’s skin. “It’s a lot of responsibility to make sure your staff members are competent in using all those supplies,” Corso adds. “As part of the specialty nurse’s role, you are the eyes, ears and hands to teach staff and physicians how these products work and to intervene differently if they’re not working as anticipated.”

Understanding which products are offered is a key component to the overall success of a pressure injury reduction program.

Visit the Member Portal to find products associated with wound care under the Wound Care, Tissue category, and items to help with positioning under the Positioning Aids, Nursing category.

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