Pressure injuries - WOC nurses, please help!

Published

Hi there! I work at a MS/SD/Tele unit in NYC, and we have some pretty high Pressure Injury ratios. We already utilize specialty beds, z flows, wedges, and we have the paper turn clocks up (not being utilized by all RNs). The most recent plan was to implement a standardized overhead call on the unit that says to reposition the patients to their other side. This has also failed. 
I am curious what nursing driven protocols are in place out there that might help our team be better at turning patients on time, and in a systematic way. 

Up Vote Up Vote ×
Specializes in Psych, Addictions, SOL (Student of Life).

The cause and treatment of Hospital Acquired Pressure Ulcers is both complex and dynamic and goes way beyond the turning of patients. If turning patients every two hours prevented this type of injury there would of course be no pressure injuries. The main cause of pressure injury is protien catabolism followed by prolonged pressure. Also failure to recognize early signs of such an injury. Areas of the body at risk for pressure injury need to be visually examined each time the patient is turned. If they are able to take foods by mouth they need to be given a diet high in Protien, collegen and Vit C (promotes collegen developement). So lab tests should include labs that address protien stores (Total Protien, Albumin/Globulin Ratio) need to be done on a regular basis in addition to rigorous attention to hygiene and turning of the patient. Does your hospital not have a wound prevention and management specialist?

Hppy

4
Up Vote Up Vote ×

Try the leaf device by smith and nephew.

1
Up Vote Up Vote ×

What is management doing to ensure that there is time for all the things that go into preventing pressure injuries (which is not by any means just turning someone q2)?

2
Up Vote Up Vote ×
Specializes in Wound Care, Med-Surg, Rehab.

What other methods are being utilized at your facility? If I had to rely on q2 turns alone, my in house pressure ulcer rate would skyrocket. I use signs in the rooms, Sitting protocols (time limits while in chair), rojo cushions, wedges and heel protectors  to offload just to name a few. I also keep track of the prealbumin. If a patient isn’t at at least 13 and has no renal issues,  I am getting in as much protein as I can. Management also has to hold the nurses and techs responsible for the q2 turns. We are all busy. Is management supportive in finding ways to incorporate all these measures? If not, it’s a tough road. 

Up Vote Up Vote ×
Specializes in retired LTC.

It's been quite some time for me but I remember also paying close attn to H&H. One attending MD went to some seminar and when he returned he started aggressively addressing anemia issues. His wound pts improved and as we looked at other pts, it was a strong prophyllactic measure that we believed was helpful.

I worked LTC/NH which was notoriously rife with pressure ulcer wounds. I guess I was lucky that my facilities were GOOD facilities that really worked HARD to avoid in-house wounds. NOT wanting to start some war of words with HOSPITAL staff, NHs do try to provide good skin management, and just as there are bad NHs, there also bad acute care facilities.

Up Vote Up Vote ×
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

Agree c hydration, protein intake, and tissue oxygenation. Other things to look at in chronic cases are Vit C levels, prealbumin and albumin, and testosterone levels. 
SCI units often see guys who have been living successfully p injury in their teens or twenties, driving, working, doing sports and all without pressure injury. And then in their mid-forties or so they start showing up c PIs on their feet, sacroiliacs, etc. Why? They’re being OK c their skin care and pressure releases. What they are doing is experiencing normal age-related testosterone level decreases— testosterone is big in tissue healing. Little things they got away c like a tightish shoe or a thick seam in their Levi’s now don’t heal. 
Long ago before TPN and TF were as regular as they are now we saw dreadful skin breakdowns constantly no matter what we did. Once they started rxing trace elements (Mg chiefly), protein, and multi vits, things got better. A good low air-loss mattress c microclimate control and air-permeable chux is a huge help. 

Up Vote Up Vote ×
Specializes in retired LTC.

Re-reading this post and am remembering that we also gave oral zinc.

One thing that I would also like to bring up is that not only are the underweight pts at high risk, but the more corpulent pts are at risk also. Hard to think that obese pts may be poorly nourished, but that is commonly a life long issue with them. Compound that with poss immunocomp conditions like MG, rhabido, sarcoid, etc , and you've got further compromise just waiting.

Strong medical diagnostics with aggressive nsg prophyllaxis  is req.

1
Up Vote Up Vote ×
Specializes in Psych, Addictions, SOL (Student of Life).
On 12/25/2020 at 6:41 PM, egg122 NP said:

Try the leaf device by smith and nephew.

love this thing!

 

Up Vote Up Vote ×
Specializes in Mental Health, Gerontology, Palliative.

For at risk people

- pressure relieving mattresses, I love the alternating air ones, however they can wierd some of the patients out. There are some bog standard non alternating air mattresses that are comparible. 

- Braden or waterlow assessment on admission for every patient and reviewed regularly, and act on the outcome if its changed. 

- High energy, high protein diets for those at risk

- Good perineal care, the manufacturers of moli pads may ensure us that they absorb all the wetness however if a patients sitting in a wet bed or soiled pad for any length of time, their skin is going to deteriorate

- I went to a seminar on pressure injuries a few years ago, it said that pressure injuries can start developing in under an hour

Up Vote Up Vote ×
+ Join the Discussion