Top 6 Facts You Need to Know about Pressure Injuries Today

Published on May 27, 2019 by Carole Jakucs, MSN, RN, PHN, CDCES

Wound care is an exciting specialty that can sometimes prove challenging.

With various wound types and multiple wound care products and treatments available, clinicians strive to stay up to date on the best practices to ensure they are providing their patients with the current standard of care.

Managing pressure injuries is one area of wound care that many wound care professionals encounter regularly, as pressure injuries are pervasive across the healthcare continuum.

Whether you work in home health, acute care or long-term care, below are some of the top facts to know about managing pressure injuries today from Don Wollheim, MD, FAPWCA, WCC, DWC.

Wollheim is a board-certified surgeon of the American Board of Surgery with 25 years of experience in general/vascular surgery and 13 years as a wound care specialist and educator. He also is a medical-legal consultant, college science instructor and clinical instructor at the Wound Care Education Institute (WCEI).

1 — Pressure injuries are dynamic

Wollheim points out that what was practiced in the past, may not be what is done today. Additionally, what is done today, may not be considered a best practice in the future.

One example is the timing of conducting a Braden Scale wound assessment for predicting skin breakdown in patients.

“For many years the practice was to conduct a Braden Scale assessment within 24 hours upon admission to a facility,” he said. “The new guideline now is conducting a Braden Scale risk assessment within eight hours of admission. This is the new standard of care and the result of scientific findings that pointed out that 24 hours may be too late for some patients as necrotic tissue can present much sooner — and as soon as six hours. Timely administration of the Braden Scale along with using it correctly is essential.”

Another common wound care practice in years past was wet-to-dry dressings. This is now considered an outdated practice and no longer considered the standard of care, Wollheim said.

2 — Terminology and documentation changes

When terminology changes, so does the required charting that accompanies the name changes — the new terms need to be used, Wollheim said.

Pressure injuries used to be called decubitus or pressure ulcers. In 2016, the National Pressure Injury Advisory Panel recommended the name change to pressure injury.

Another recent change has been an update to the staging system of pressure injuries along with their numbering. Roman numerals are no longer used, we are now using Arabic numbers, Wollheim said.

3 — Pay attention to the healing rate of wounds

Clinicians caring for wounds will want to monitor how quickly a wound is healing, Wollheim explained.

“We want a wound to heal as quickly as possible,” he said. “The goal is to see a wound reduce in its size by 50% [in length and width] within three to four weeks of initiating treatment.”

If the wound does not heal quickly as expected, clinicians should consider if a change of treatment is necessary.

4 — Use TCOM to predict who will likely respond to hyperbaric treatment

One new trend in wound care is the use of transcutaneous oximetry, also known as TCOM, Wollheim said.

“Using TCOM tells you how much oxygen is in the capillaries surrounding a wound bed,” he said. “Knowing this level is very helpful to determine if a patient is more likely to respond to hyperbaric oxygen therapy or not.”

There is a good chance a wound won’t heal if the TCOM level is 30, according to Wollheim. But if the TCOM is 40 or higher, there is a good chance the wound will respond to hyperbaric oxygen therapy.

5 — Educate colleagues, as needed

When knowledgeable and certified wound care clinicians encounter an order for the wrong materials or treatment, or see a colleague practicing in an outdated or unproven practice, be proactive in educating them, Wollheim said.

“When differences arise, it’s best to approach an ordering clinician or colleague in a non-judgmental and collaborative way,” he said. “You’ll likely get less resistance, and the other person may realize they can learn something from you.”

Another method to help other clinicians learn more about wound care in your organization is to schedule lunch-and-learn webinars or educational sessions provided by company reps on the various products used in your institution.

“Never underestimate the power of free food. Scheduling a time for all to view a webinar at lunch-and-learn in-service is a good way to get everyone on the same page about the appropriate use of specific products, procedures and treatments,” he said.

Holding monthly patient care meetings with all the disciplines involved in wound care is another way to encourage a dialogue, Wollheim said.

For example, ordering physicians, nurses, physical therapists, dietitians and even assistive personnel can be on-hand to collaborate with staff such as:

  • Discussing current treatment approaches
  • Making suggestions if something is not working
  • Ensuring everyone is using the same terminology

6 — Ensure everyone knows how to use new products

Wollheim pointed out switching from one brand of a wound care product to another may involve different sets of instructions for their use.

“Anytime you change brands, you need to make sure all staff know how to use the new products,” he said. “This may require an in-service to make sure all staff are on the same page and using the current products correctly as the manufacturer intended to achieve the best outcomes for patients.

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Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.