If you have ever known someone with a pressure injury, also known as a pressure sore or pressure ulcer, you know how miserable they can be. As the director of skilled nursing facility clinical practice, I know many residents arriving from hospitals who are not yet ready to go home because they need rehabilitation or other skilled nursing services.
Pressure injuries affect 2.5 million residents, lead to 60,000 deaths and cost $9 to $11.6 billion per year in the United States, according to the Agency for Healthcare Research and Quality. Moreover, pressure injuries are painful and detrimental to patient quality of life.
People who acquire pressure injuries face an average of five extra days in the hospital, according to the National Medicare Patient Safety Monitoring System Study. The study also shows 22 percent are readmitted to the hospital within 30 days of discharge.
Typically, pressure injuries occur on a bony part of the body and are not just the result of pressure. Other factors include:
- Shear, when skin is pulled in one direction and tissue beaneath is pulled in another
- Microclimate, a combination of temperature and moisture.
People who spend much of the day in bed or sitting are at increased risk of developing a pressure injury.
One of our main objectives at Augustana Care is to reduce the incidence of pressure injuries and help residents heal faster should they acquire these injuries. Nurses can use a number of tools to treat pressure injuries, including one known as GlideWear. Augustana Care began collaborating with Tamarack Habilitation Technologies, the maker of GlideWear, almost three years ago.
Initially, Tamarack brought a friction management technology to us in the form of a specially-designed sock made with low-friction fabric. Their product line has grown to include socks, wheelchair cushion and headrest covers, undergarments and prosthetic liner patches. The products utilize a patented, dual-layer strategic friction management fabric technology. Friction is equal to 0.18, roughly the same as a car tire on slick ice at minus-40 degrees Fahrenheit.
Recently, our rehabilitation nurses used GlideWear for a woman whose hips, thighs, buttocks and chest had been burned in the shower. She could barely get out of bed and cried out in pain when she tried to sit up. She had to take pain medication every four hours just to be able to tolerate her situation.
The woman began wearing the shorts and, after a while, began coming out of her room and sitting in the dining room with others. Her need for pain medication decreased as well. Nurses told me that when she returned home, she sent a thank you note expressing gratitude for the help she received. I was very happy to learn her condition had improved.
Another gentleman who was quadriplegic came to us initially with nine pressure injuries. The Tamarack team created several custom-made pieces for him, which helped the wounds on his feet, sacrum and hip area heal faster than we expected.
Other tools to combat pressure injuries
At Augustana Care, we conduct a comprehensive skin evaluation using a measurement called the Braden scale, which assigns a numeric value to risk of skin damage. Physical and occupational therapists assist in assessing the risks residents face, and staff are trained to conduct assessments so they can spot problem areas quickly. I would highly recommend using the Braden scale to any healthcare workers who may be dealing with pressure injuries.
Following an individualized and comprehensive skin assessment, common risk reduction strategies include:
- Positioning off at-risk areas
- Keeping skin clean and dry
- Refraining from vigorously massaging or rubbing areas at risk of pressure injury as friction can cause tissue damage and deterioration
- Maintaining or restoring continence levels
- Reducing excessive exposure to moisture for a specific area
- Keeping the patient hydrated and the skin moisturized with emollients
We may ask our wound care team to follow the residents to see what exactly may be causing a pressure injury. An in-house dietitian also looks at residents to determine nutritional status. In addition, we use pressure relief mattresses that alternate air pressure on the surface of beds in skilled nursing and rehabilitation areas.
The most important part when dealing with pressure injuries is prevention. Our efforts are focused on the healing process, and the comments and feedback we have received to date are telling us we are on the right track.
Julie Thurn is the corporate director of skilled nursing facility clinical practice at Augustana Care. She is a registered nurse, certified registered nurse assessment coordinator and serves on the National Pressure Ulcer Advisory Panel board. She can be reached at firstname.lastname@example.org.