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Posted: January 13th, 2024

Reducing Pressure Injuries in Hospitalized Patients

Reducing Pressure Injuries in Hospitalized Patients

Pressure injuries, also known as pressure ulcers or bed sores, are localized damage to the skin and underlying tissue caused by prolonged pressure, shear, or friction. They are a common and costly problem in health care settings, affecting patients’ quality of life, increasing the risk of infection and mortality, and consuming scarce resources. According to the International Guideline (Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline), the prevalence of pressure injuries in acute care hospitals ranges from 7% to 23%, and the incidence ranges from 0.4% to 38%.

Pressure injuries can be prevented by implementing evidence-based practices that address the main risk factors, such as immobility, malnutrition, moisture, and medical devices. The following are some of the best practices recommended by the International Guideline and other sources for preventing pressure injuries in hospitalized patients:

– Assess the patient’s risk for developing pressure injuries using a valid and reliable tool, such as the Braden Scale or the Waterlow Risk Assessment, at admission and regularly thereafter.
– Inspect the patient’s skin daily for signs of pressure injury, especially over bony prominences and areas exposed to medical devices.
– Reposition the patient at least every two hours, or more frequently if needed, to relieve pressure and improve blood circulation. Use a repositioning schedule and document the frequency and method of repositioning.
– Use appropriate support surfaces, such as mattresses, overlays, cushions, or dressings, that redistribute pressure and reduce shear and friction. Choose the support surface based on the patient’s risk level, comfort, mobility, and clinical condition.
– Provide adequate nutrition and hydration to the patient, as malnutrition and dehydration can impair wound healing and increase the risk of pressure injury. Consult a registered dietitian or nutritionist for individualized nutritional assessment and intervention.
– Manage moisture and incontinence, as excessive moisture can weaken the skin and make it more susceptible to damage. Use gentle cleansing agents, moisturizers, barrier creams, or absorbent pads to protect the skin from urine, feces, sweat, or wound drainage.
– Educate the patient and family about the causes, prevention, and treatment of pressure injuries. Involve them in the care plan and encourage them to participate in preventive measures, such as repositioning, skin inspection, and nutrition.
– Monitor and evaluate the effectiveness of the preventive interventions. Measure and report the pressure injury rates and practices regularly. Identify gaps and areas for improvement. Implement quality improvement initiatives to reduce hospital-acquired pressure injuries.

By following these best practices, health care providers can reduce the incidence and severity of pressure injuries in hospitalized patients, improve their outcomes and satisfaction, and save costs.

Works Cited

: European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), Pan Pacific Pressure Injury Alliance (PPPIA). Prevention and Treatment of Pressure Ulcers/Injuries essy pro: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.

: The Joint Commission. Quick Safety 25: Preventing pressure injuries (Updated March 2022). https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-25-preventing-pressure-injuries/preventing-pressure-injuries/

: Holbrook S., O’Brien-Malone C., Barton A., Harper K. A quality improvement initiative to reduce hospital-acquired pressure injuries (HAPI) in an acute inpatient setting by improving patient education and seating. Wound Practice & Research 2021; 29(4):198-205.

: Agency for Healthcare Research and Quality (AHRQ). Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/index.html

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