Pressure Injuries? (Don’t) Say It Ain’t So!

Mounting pressure to call pressure injuries (aka pressure ulcers) something else has caused a stir – and clinicians in wound care are feeling the heat. Find out why.

Pressury Injuries - Don't Say It Ain't So

One of the most basic principles of healing a wound is to determine the cause – and then remove it. It sounds so simple, doesn’t it? But this is easier said than done, as many wounds have similar characteristics, and we don’t always have all the facts at our disposal in order to pinpoint the cause.

Unfortunately, this process has become further – and unnecessarily – complicated, thanks to increasing pressure (no pun intended) on wound clinicians to name a pressure injury something else. See? We told you it was complicated. Here’s what you need to know.

Why all the pressure?

A pressure injury is still a pressure injury, no matter what it’s called. In the end, whether it’s labeled a bedsore, decubitus or “de-cube,” this type of wound is bad news for the patient and caregiver. No wound clinician wants to see these develop under their watch.

But the emphasis on naming pressure injuries something else has increased, because traditionally, pressure injuries are equated to poor nursing care. As Florence Night­in­gale, the “Mother of Nursing,” wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing.”

Unfortunately, as more hospital complications’ data is made available to the public, reports of complications (such as pressure injuries) increasingly have a negative effect on individual perceptions – right or wrong – regarding the care a hospital delivers.

To make matters worse

In addition, recent attention given to Medicare’s “present on admission” rule and “never” events has elevated pressure injuries high up the chain of “no-no’s,” and puts the hospital at risk for non-reimbursement. As a result, many private insurers have followed Medicare’s lead in denying coverage for pressure injuries that occur in the hospital. Unfortunately, all the focus on reimbursement is beginning to challenge even the best wound care experts, who simply want to get the patient’s wound healed.

Today, mounting pressure from upper management has caregivers trying to bargain and rationalize their way out of calling it what it is (a pressure injury), and instead calling it something else, sometimes in desperation. Here are some examples:

  • It’s a bruise – not a deep-tissue injury.
  • This is a shearing ulcer, not a pressure injury.
  • It’s not an ischial pressure injury, but a diabetic ulcer because the patient is a diabetic.

Sadly, wound care experts are being forced to question and doubt themselves because money, quality assurance, and reputation are on the line when an in-house wound is labeled a pressure injury.

What should you do?

Just like a detective in a crime scene investigation, determining wound etiology requires us to gather all the facts. Once the facts are in, systematically comparing and contrasting the clinical findings aids differential identification in order to pin down the type of wound present.

So as a “wound detective,” it’s important that we assess and investigate all the following when searching for the cause:

  • patient’s medical history
  • recent activities (such as surgery, extensive X-rays, or long emergency-
    department waits)
  • comorbidities
  • specific wound characteristics, such as location, distribution, shape, wound bed, and surrounding skin.

Naming the wound is an important first step in intervening. If the wound is caused by pressure, call it a pressure injury and jump into action. Remove the cause, heal the wound, and prevent further breakdown. Quite simply, don’t let yourself be influenced by those who aren’t experts in wound care.

Are you feeling the pressure?

Have you felt pressure from upper management at your facility to name pressure injuries something else? How do you deal with it? Does your facility support the basic idea of calling a pressure injury what it is, and getting down to the business of healing the wound? We would love to hear about your experiences or thoughts regarding this topic. Please leave your comments below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

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Mounting pressure to call pressure injuries (aka pressure ulcers) something else has caused a stir - and clinicians are feeling the heat. Find out why.

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