Jordan Ellis
Hospital-acquired pressure injuries (HAPIs) are a significant health issue, causing harm, discomfort, and even death for patients, and posing a financial burden for hospitals. HAPIs are defined by the National Pressure Injury Coalition as localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. They are typically caused by low mobility, localized pressure, circulatory conditions, and other factors. To prevent HAPIs, hospitals should implement evidence-based strategies, provide specialized education for healthcare teams, and utilize a multidisciplinary approach. Preventative measures such as good skin care, regular repositioning of patients, and the use of pressure-reducing devices are also crucial.
| Characteristics | Values |
|---|---|
| Definition | Localized damage to the skin or underlying tissues |
| Cause | Lying down or sitting in one place for too long without much movement |
| Risk factors | Low mobility, exposure to localized pressure, circulatory conditions, age, general poor health condition, sedation, paralysis, coma |
| Prevention techniques | Increasing mobilization, ambulation, and repositioning, using pressure-reducing cushions, mattresses and other devices, providing good skin care |
| Prevention strategies | Implementing evidence-based strategies, empowering healthcare teams with specialized education, utilizing a multidisciplinary team |
| Impact | Patient harm, discomfort, death, increased length of stay, higher readmission rates, financial burden on hospitals |
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What You'll Learn
Implement evidence-based strategies and educate healthcare teams
Pressure injuries (PIs) are a significant health concern, with over 2.5 million Americans developing them annually during their hospital stay. These injuries are caused by localized pressure, circulatory conditions, and other factors such as age, poor health, and sedation, which lead to low mobility. As a result, hospitals face a substantial financial burden, with each Stage 3 and 4 Pressure Injury costing up to $70,000 in treatment.
To address this issue, hospitals should implement evidence-based strategies and educate their healthcare teams. This includes ensuring that all patient care providers are trained in PI prevention techniques. For example, good skin care practices, regularly changing patients' positions in bed, and using pressure-reducing devices are essential. Hospitals should also conduct regular assessments of patients' risk factors, such as malnutrition, and provide interventions such as supplemental nutrition.
Furthermore, a multidisciplinary approach has been shown to be more effective than a single intervention approach. This involves a team of healthcare professionals, including nurses, dietitians or nutritionists, and other specialists, working together to prevent and manage PIs. Hospitals should also utilize data-driven approaches, such as machine learning models, to identify and predict PIs, as suggested by the Center for Medicare and Medicaid.
Additionally, ongoing education and training in PI prevention and management are crucial. This includes educating nurses and nursing assistants about PI prevention, identification, and management. Hospitals can also benefit from partnerships with specialized organizations, such as Wound Care Advantage, to access additional resources and expertise.
By implementing these evidence-based strategies and educating healthcare teams, hospitals can significantly improve patient outcomes and reduce the prevalence of PIs, ultimately improving the quality of care and financial well-being.
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Improve patient nutrition and regularly assess their weight
Hospital-acquired pressure injuries (HAPIs) are a significant concern, affecting over 2.5 million Americans annually. These injuries not only cause harm and discomfort but also lead to increased healthcare costs and even death in some cases. To prevent HAPIs, it is crucial to address the underlying factors that contribute to their development. One key factor is the nutritional status and weight of the patient.
Hospitalized individuals are at high risk for undernutrition, which can impair their body's ability to withstand pressure and heal wounds. By improving patient nutrition, hospitals can strengthen their skin and soft tissue resilience, making them less susceptible to pressure injuries. This involves using valid tools to assess each patient's risk for malnutrition and referring at-risk patients to registered dietitians or nutritionists.
Supplemental nutrition may be provided to patients at risk, and their weight should be monitored regularly. This includes assessing the adequacy of oral, enteral, and parenteral intake to ensure they are receiving sufficient nutrients. Additionally, hospitals should consider implementing a multidisciplinary approach, as evidence suggests it is more effective in reducing the prevalence of pressure injuries compared to single intervention strategies.
By addressing patient nutrition and regularly assessing their weight, hospitals can proactively contribute to the prevention of HAPIs. This not only improves patient outcomes and reduces discomfort but also helps mitigate financial burdens associated with treating pressure injuries, which can cost up to $70,000 per occurrence.
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Turn and reposition patients to reduce immobility
Pressure injuries (PIs) are a significant health issue, and one of the biggest challenges hospitals face. Hospital-acquired PIs (HAPIs) are the most frequent preventable event, affecting over 2.5 million Americans annually. HAPIs are defined as localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or caused by a medical device. They are typically caused by low mobility, exposure to localized pressure, circulatory conditions, and other predisposing factors.
One strategy to reduce the incidence of PIs among hospitalized patients is to turn and reposition at-risk patients to reduce immobility. Turning and repositioning help to redistribute and minimize direct pressure on the targeted skin and enhance blood perfusion in the affected areas. Most clinical guidelines recommend a substantial change in a patient's position according to their health status. However, the optimal time interval between position changes has not been established. Some studies have found that 2-hourly turning intervals were not sufficient to prevent PIs, while 4-hourly turning intervals with foam mattresses showed a significant reduction in PI incidence.
It is important to assess each patient's individual needs when planning a schedule for turning and repositioning. Factors to consider include the patient's body size, level of immobility, exposure to shear, skin moisture, and perfusion. Additionally, the use of pressure-relieving devices, such as foam mattresses or pressure-redistributing mattresses, can be considered when placing patients on support surfaces.
While turning and repositioning can be effective in preventing PIs, it is not the only strategy. Other strategies to prevent PIs in patients with immobility include the use of patient hoists, repositioning sheets, and slide sheets. Play experts can also be used to encourage children to move around. Furthermore, accurate evaluation and monitoring of patients from the moment of admission can help predict their risk of developing PIs, allowing for early intervention and appropriate care.
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Use pressure-reducing devices and support surfaces
Pressure-reducing devices and support surfaces are crucial in preventing hospital-acquired pressure injuries (HAPIs). HAPIs are localized damage to the skin and underlying soft tissues, typically occurring over bony prominences or due to medical devices. They are caused by intense and/or prolonged pressure, pressure in combination with shear, friction, and moisture.
To prevent HAPIs, it is essential to use pressure-reducing devices and support surfaces that alleviate pressure on vulnerable areas. These devices and surfaces are designed to distribute weight more evenly, reducing the amount of pressure on any one area. This is especially important for patients with limited mobility, as they may be unable to shift their position frequently to relieve pressure.
When selecting pressure-reducing devices and support surfaces, it is important to consider the patient's body size, level of immobility, exposure to shear, skin moisture, and perfusion. For example, a bed-bound patient with high exposure to shear forces may benefit from a low-friction support surface, while a patient with moist skin may require a moisture-wicking surface to prevent skin breakdown.
Hospitals can utilize pressure-reducing mattresses, overlays, cushions, and heel protectors to alleviate pressure. For example, a pressure-reducing mattress can be used to support a patient's entire body, while heel protectors can be employed to target specific pressure points. Additionally, specialized seating solutions, such as pressure-relieving chairs or cushions, can be provided for patients who spend extended periods in a seated position.
The use of pressure-reducing devices and support surfaces is a critical component of HAPI prevention. By alleviating pressure, these tools help maintain skin integrity and promote better blood flow, reducing the risk of tissue breakdown and the formation of pressure injuries. Through the strategic use of these devices and surfaces, healthcare providers can significantly reduce the occurrence of HAPIs and improve patient outcomes.
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Provide good skin care and use pressure-reducing mattresses
Pressure injuries (PIs) are a significant health issue, with over 2.5 million Americans developing them annually. Hospital-acquired PIs (HAPIs) are the most frequent preventable event in hospitals. Localized damage to the skin and underlying soft tissue, usually over a bony prominence or caused by a medical device, characterises pressure injuries. They are typically caused by remaining in one position for too long without movement.
Good skin care is essential to prevent HAPIs. It is important to keep the skin from becoming too dry or too moist, as either condition increases the likelihood of skin damage. Creams and lotions should be applied in the right amounts, and it is important not to rub too hard, as this could damage the skin, especially if it is already sensitive.
Additionally, pressure-reducing mattresses and support surfaces can effectively lower the risk of pressure injuries. These mattresses are designed to redistribute pressure on the body to increase blood flow and relieve pressure on vulnerable parts of the body. There are several types of pressure-reducing mattresses available:
- Special foam mattresses
- Gel-filled support surfaces
- Air cushions
- Reactive support surfaces
- Alternating pressure mattresses
When choosing a mattress, it is important to consider the patient's level of mobility, shear reduction, location of PUs, and risk of developing new PUs.
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Frequently asked questions
HAPIs are pressure injuries that develop during a patient’s stay in a medical facility or are not recorded during admission. They are typically caused by localized damage to the skin and/or underlying soft tissue, often due to prolonged pressure, friction, or moisture. HAPIs can result in patient harm, discomfort, prolonged hospital stays, and even death.
Risk factors for developing HAPIs include low mobility, exposure to localized pressure, circulatory conditions, and other predisposing factors. Age, general health condition, sedation, or paralysis can also contribute to immobility. Hospitalized individuals are also at risk of undernutrition, which can impact the tolerance of soft tissue for pressure. Additionally, tubes, drains, and other healthcare equipment can cause pressure injuries.
Preventative measures for HAPIs include increasing patient mobility and regular repositioning, providing good skin care, using pressure-reducing devices such as cushions or mattresses, and ensuring adequate nutrition. A multidisciplinary approach involving specialized education and training for healthcare teams has been shown to be effective in reducing HAPI rates.
