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Pressure Injury Management: A 360-Degree Approach

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

Skilled nursing facilities face a critical challenge as National Pressure Injury Advisory Panel reports reveal that nearly thirty percent of patients are at risk of developing pressure injuries.

Failure to act can result in devastating consequences for patients, including long-term hospitalization, infection, and even death. Additionally, the potential legal and financial ramifications of such incidents are staggering, with lawsuits, regulatory fines, and reputational damage all potential outcomes.

To mitigate the risks associated with pressure injuries, skilled nursing facilities must adopt a proactive, multi-faceted approach to assessment, prevention, and treatment. Using a holistic approach, healthcare providers can reduce the incidence rate of pressure injuries and ensure that patients receive the best possible care.

Let’s take a closer look at the importance of adopting a comprehensive approach to this aspect of care and discuss best practice guidelines for pressure injury prevention and management.


The Importance of Pressure Injury Prevention and Management

In addition to being essential for providing quality care to patients, standardized pressure injury protocols can have a favorable impact on a facility’s operations and bottom line.

Cost Savings

Clinical studies show that implementing a pressure injury prevention program can result in significant savings for long-term care facilities. By preventing just one stage three or four pressure injury, a facility could avoid over $40,000 in treatment costs.

This cost avoidance is because pressure injuries require a significant amount of resources and treatment, including wound dressings, specialized beds, and medications. By preventing pressure injuries, facilities can save money and allocate those resources to other care areas.

Quality of Care

Pressure injuries can cause serious health complications, such as infections, sepsis, and even death. By preventing pressure injuries, facilities can reduce the risk of these complications and provide better patient outcomes.

Increased or Preserved Funding

Facilities that have a high incidence of pressure injuries may experience severe penalties that can even impact funding. Medicare and Medicaid have established quality metrics that facilities must meet to receive support. Preventing pressure injuries can help facilities meet these metrics and ensure they receive the funding to provide quality care.

Reduced Legal Exposure

With over 17,000 pressure injury-related lawsuits happening each year, facilities that fail to prevent or manage pressure injuries are at an increased risk of facing legal action. By preventing and managing pressure injuries, organizations can reduce their legal exposure and protect themselves from potential lawsuits.

An Evidence-Based Approach to Pressure Wound Care

Thankfully, tackling responsible wound care is achievable through a comprehensive 360-degree approach. A 360 pressure injury prevention and management strategy has been proven to be highly effective. Its five steps can be broken down as follows.

1. Standardized Wound Assessment

The first step in the Wound Prevention and Management Model is to assess and reassess patients. This involves selecting and using validated patient assessment tools and identifying risk and mitigating factors that may impact skin integrity and wound healing.

It is essential to assess patients regularly to detect any changes in their condition that may indicate the development of pressure injuries. Early detection can help prevent the wound from worsening by allowing healthcare professionals to intervene promptly. The use of digital imaging can also be valuable at this stage.

During the assessment, risk and causal factors that may impact skin integrity and wound healing should be determined. This involves looking at the resident’s physical, emotional, and lifestyle factors and potential for self-management. It also involves assessing the systems in place, such as dependency status and communication.

Once the risk factors have been identified, the healthcare team can work to mitigate them. For example, if a patient is at risk of developing a pressure injury due to immobility, the team can implement turning schedules to redistribute  pressure on certain areas of the body. If your facility is short-staffed, consider investing in therapeutic support systems that may reduce the frequency need for repositioning schedules

If a patient already has a wound, it is essential to complete a wound assessment immediately upon arrival. This involves recording the wound’s size, depth, stage, and identifying any signs of infection. Healthcare professionals must also consider the patient’s pain levels and emotional state during assessment.

2. Set SMART Goals

Setting objectives for all stages of wound prevention, healing, non-healing, and non-healable wounds is the next step. This involves identifying goals based on the prevention or ability to heal wounds, as well as quality-of-life and symptom-control goals.

The goals should be specific, measurable, achievable, relevant, and time-bound. For example, a goal may be to prevent a pressure injury from developing with customized care plans upon admission for each admission.

3. Assemble a Multi-Disciplinary Team

The next step is to assemble the healthcare team. This involves identifying appropriate healthcare professionals and service providers, enlisting the patient and their family and caregivers as part of the team, and ensuring organizational and system support.

A multidisciplinary approach is essential to the success of this stage. This may involve working with wound care nurses, physical therapists, dieticians, and other healthcare professionals to develop and implement a comprehensive care plan. Clear coordination and operating procedures should be established to ensure that efficiency effective care is delivered

4. Establish and Implement a Plan of Care

The next step is to formulate and carry out an evidence-based plan to address the root causes or aggravating factors that compromise skin integrity. This takes into account aspects such as a patient’s physical, emotional, and social needs, their wound (if necessary), and any systemic or environmental difficulties.

Optimizing the local wound environment, in particular, is crucial because it helps to create the conditions necessary for proper wound healing. This can involve proper cleansing, removing dead or infected tissue, accounting for bacterial balance, and managing moisture.

To accomplish this, healthcare professionals must carefully select the appropriate diagnostic tools, dressing and/or advanced therapy.

5. Evaluate Efforts and Outcomes

Last but not least, evaluate team efforts and changes in outcomes. After implementing a plan of care, it’s essential to determine whether the outcomes have met the goals of care. If the goals are partially met or unmet, reassessing the patient, wound, environment, and system will be required.

To support prevention and lower the chance of recurrence, sustainability is essential. To prevent and treat pressure injuries, it is crucial to continually assess the results and to reevaluate the patient and the care plan.

Following the model outlined above, medical professionals can take a 360-degree approach to prevent and manage pressure injuries. It’s a collaborative approach that involves the patient, their family, and caregivers, as well as healthcare professionals and service providers.

Final Thoughts: Best Practice Guidelines for Pressure Injury Prevention and Management

Preventing and managing pressure injuries is an essential aspect of providing quality care to patients in long-term care facilities. By taking a holistic approach and using the Wound Prevention and Management Model, medical professionals can prevent pressure injuries and provide better patient outcomes.

Additionally, benefits such as cost savings, improved compliance, and reduced legal exposure can significantly impact a facility’s operations and bottom line.

At Joerns Healthcare, we understand the importance of preventing and managing pressure injuries, and we are dedicated to providing healthcare professionals with the tools and resources they need.

Our team is knowledgeable, service-oriented, and committed to helping our clients prevent pressure injuries and improve patient outcomes using the latest solutions and data-driven expertise. If you want to learn more about our pressure injury prevention and management solutions, contact us today.



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