Pressure Injuries

Hospital-acquired Pressure Injuries

According to a recent U.S. study, 4-8 percent of all inpatients will develop hospital-acquired pressure injuries. In addition to pain and risk for serious infections, pressure injuries result in increased length of stay, readmissions and $2.41 billion in excess healthcare costs. Pressure injury prevention requires an interdisciplinary approach to care. Certain aspects of pressure injury prevention care are highly routinized, but the care must also be tailored to the specific risk profile of each patient. Pressure injury prevention can be a shared  opportunity to empower  patients and their family through education, prevention and treatment strategies.

Several evidence-based practices have been shown to be effective in reducing the occurrence of pressure injuries. They include:

  • Patient & family engagement in plan of care.
  • Executive leadership and continuous engagement in reducing harm to patients.
  • A dedicated, multidisciplinary team that meets frequently to identify trends and continuous improvement opportunities.
  • Early identification, including a complete and comprehensive skin assessment upon  admission and once a shift
  • Consider a 2 RN assessment as an opportunity for improvement
  • Education to clinical team on how to identify, stage and document pressure injuries.
  • Standard pressure-relieving surfaces across the continuum.
    • Incidence and prevalence of certain health conditions pre-dispose patients to increased risks in developing a pressure injury. Special considerations for your pressure injury prevention program should include risk assessment to identify vulnerable populations such as: mobility status, nutrition, moisture and patients requiring support with medical devices.  Certain ethnicities, including dark-skinned populations are at risk of developing pressure injuries. Identify barriers addressing health disparity and provide education to patients and families on prevention.
    • Critically ill patients in the intensive care units.
  • Effective communication and team-based coordinated care.

Getting Started

Pressure injury prevention is a collaborative and interdisciplinary approach. Clinical practice guidelines recommend a standard method in prevention yet requires a tailored program to meet the individual needs of each patient. Whether you are initiating a prevention program for your facility or looking at program enhancement, evaluate your program’s fundamental elements with the WSHA Top Ten Best Practices.

WOCN: Guideline for Prevention and Management of Pressure Ulcers (Injuries)

Toolkits & Resources

The following toolkits and resources support our hospitals with implementing best practices in the prevention of pressure injuries and draw upon the most current and evidence-based literature.  These resources include key components in prevention, treatment, wound identification, including illustration as well as tools utilized in hospital clinical quality improvement.

Prevention and Treatment of Pressure Ulcers: Quick Reference Guide

AHRQ: Preventing Pressure Ulcers in Hospitals

IHI: How-to Guide: Prevent Pressure Ulcers

NPUAP: Prevention and Treatment of Pressure Ulcers: Clinical Practice and Guideline

NPUAP: Pressure Injury Staging Illustrations

NPUAP: Pressure Injury Prevention Points

NPUAP: Best Practice for Medical Device-Related Pressure Injuries Posters

NPUAP: Pressure Ulcer Root Cause Analysis Template

NPUAP: Support Surface Standards Initiative- Terms and Definitions

Measure definition sheet: AHRQ PSI #03 Specifications (Updated June 2018)

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