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5 Evidence-Based Practices for Pressure Injury Management

Written by: Michael Fragala, PhD, MBA, RN, WCC, CSPHP, AMS

Pressure injuries are a prominent concern in long-term care, with over 28% of nursing home residents being impacted by them. Taking into account the financial aspects of pressure injuries, as well as their effects on patient safety and satisfaction, an effective pressure injury management strategy must be developed and implemented to reduce their prevalence and impact on residents.

But what is the most effective way to manage pressure injuries?

An evidence-based approach is key to reducing pressure injuries and managing their associated risks.


The 4 Stages of Pressure Injuries

Pressure injuries come in varied severities, each requiring a uniquely tailored treatment plan. Stages one and two can be successfully treated fairly rapidly, but as the severity progresses to stages three and four, effective treatments become more complex, and recovery timelines are prolonged.

Pressure injury stage one: At the early stages of pressure injury  development, even minor changes in skin color and temperature can be an indicator. Skin redness with increased warmth or soreness are common signs at stage one, so residents should be monitored closely for further advancements.

Although there is no single treatment that will work for all residents, repositioning is an essential step for both prevention and treatment . Specialized therapeutic surfacesfoam positioners, and repositioning aids can help ease pain, decrease inflammation, and improve healing outcomes.

Pressure injury stage two: At this stage, the skin is broken, and an open wound has formed. This is a partial-thickness skin loss, with exposed dermis, often covering a small area but size is varying.

During this stage, it is vital to take the necessary precautions to reduce the risk of infection and encourage optimal healing results. It is important to cleanse the wound regularly and apply fresh dressing material shortly afterward. Doing so can help lessen pain,, ensure proper hydration, and reduce the likelihood of infection or delayed healing.

Pressure injury stage three: At this stage, a pressure injury has penetrated deeper fully through thickness of skin to adipose tissue. In addition, dead tissue may be present in the wound, requiring proper assessment and treatment by a trained healthcare professional.

Treatment for stage three pressure injuries can involve various components, such as wound debridement to remove infected or dead tissue, antimicrobial therapy to reduce infection risk, and advanced wound care products such as NPWT to aid in healing. Early detection and identification of stage three injuries  is necessary to ensure effective treatment is started immediately.

Pressure injury stage fourWhen a pressure injury reaches stage four, the wound is serious and can be quite painful. Trauma to the underlying muscle, tendon, or bone tissue has occurred, and advanced treatments are necessary for healing and tissue reconstruction.

Electrical stimulation, surgery, and other specialized medical equipment may be called for to reduce swelling and redistribute pressure. Left untreated, it may extend further into the body and cause even more harm. Thankfully, with the proper care and attention from trained healthcare professionals, this condition can be managed effectively.

Lack of timely and proper treatment can lead to serious infection resulting in complications and negative outcomes. Below are the five evidence-based pressure injury management practices.

5 Evidence-Based Practices for Pressure Injury Management

1. Standardized Risk Assessments

The most important practice for pressure injury management is regular risk assessments of residents. Early detection and careful monitoring are key elements when managing pressure injuries and their associated risks. Conduct the first assessment as soon as possible after admission. Subsequent ones should occur weekly

Structured processes such as Braden or Norton Scales can be used by nurses to effectively assess risks associated with pressure injury management.

2. Precise Wound Assessment

Wounds must undergo a thorough evaluation, including documentation of the exact location and characteristics. To reduce delayed healing, each wound should be regularly assessed and monitored to ensure the right level of care is provided.

Digital wound imaging plays a crucial role in wound assessment and staging by providing a non-invasive, accurate, and cost-effective way to assess wounds. It allows healthcare providers to calculate the area, length, width and depth of a wound in seconds. The images also provide documentary evidence of a wound’s progression. Nurses can then compare current and past images to assess the effectiveness of treatment and adjust if necessary.

Healthcare providers can also upload digital wound images into a patient’s Electronic Medical Record (EMR),  allowing for better communication and collaboration among the patient’s care team.

3. Pressure Redistribution and Repositioning

Taking steps like implementing active pressure redistribution for immobile residents is becoming increasingly important for pressure injury prevention. By being proactive, you can improve their quality of life and prevent unnecessary skin damage from occurring.

Active pressure redistribution techniques involve regularly repositioning the patient and using ergonomically designed lifting equipment or low friction slide sheets to redistribute their weight. This decreases the risk of holding on to too much pressure in isolated areas and promotes circulation.

4. Proper Nutrition and Hydration

Nutritious meals provide balanced nutrients to help maintain energy and body weight levels. Adequate hydration supports good skin health, especially for residents often confined to beds or wheelchairs for lengthy periods.

There should be an effective nutrition plan in place to ensure residents have access to nutritious food options that meet their individual dietary needs. Furthermore, healthcare teams should routinely assess resident fluid intake, as well as monitor skin integrity on a routine basis to recognize any changes early on.

5. Proactively Manage Bacterial Burden

Proper wound management requires careful attention to minimize bacterial burden and combat infection, which can hinder the healing process while increasing the risk of complications. A targeted treatment plan is necessary to reduce bacteria levels. Solutions include antibiotics or antimicrobials along with appropriate dressings for successful results.

Conclusion: Pressure Injury Management Best Practices

Pressure injury management is a critical component of overall patient care. Pressure injuries are best managed by conducting risk assessments followed by early and proper treatment to prevent delayed healing and reduce the risk of complications. Healthcare teams can also reduce pressure injuries using specialized therapeutic surfaces and equipment.

Digital Wound Imaging CTA

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