Pressure injury prevention

Progressive mobility

Pressure injuries are defined as localized damage to the skin and/or underlying tissue as a result of pressure or pressure in combination with shear.1 While pressure injuries appear to be on a gradual decline, these injuries can cause a great deal of harm—both to the patients that suffer from them and to the healthcare facilities that care for them.

Patients that develop pressure injuries can suffer from a wide array of health complications, including pain, deformity, infection and death.1

Repositioning

While there are a number of contributing factors associated with pressure injuries, the primary factor is immobility—so it’s important that any pressure injury-prevention plan incorporate early mobility.1 Early mobilization interventions for pressure injury prevention/ treatment can be divided into two categories: repositioning and mobilization.1

Repositioning consists of changing a patient’s position in either a lying or seated position.1 While in the lying position, the greatest area of concern for pressure injury development is the sacral area.1 To protect this area, it’s recommended that patients are placed in a 30-degree side-lying position to relieve pressure.1 Facilities should determine a patient’s turning schedule based on an individualized assessment of pressure injury risk.1

While repositioning, it’s recommended that facilities use manual handling techniques and equipment that reduce friction and shear.1 When patients are in the supine position, the head of the bed should not exceed 30 degrees, unless contraindicated.1 With head-of-bed elevation, the sacrum is subjected to shear/stress-strain and pressure; therefore, the bed should be kept as flat as possible.1

Mobilization

When mobilizing patients with, or at risk for, a pressure injury, certain considerations should be taken into account. If a patient cannot ambulate safely on their own, it’s recommended that a mechanical lift be utilized.1 Do not leave safe patient handling equipment underneath a patient after a transfer unless the equipment is designed for that purpose.1

When positioning patients in a seated position, the patient should be reclined with their legs elevated.1 A 30-degree tilt angle is recommended to prevent the individual from sliding forward in the chair or wheelchair.1 These measures have been shown to reduce shear and pressure on the sacrum, ischial tuberosities and coccyx.1 If a patient has an ischial or sacral pressure injury, implement a progressive seating schedule based on the response of the pressure injury and the individual’s tolerance.10

Safe mobility

Research shows that a comprehensive early mobility program can reduce pressure injuries.1,10,11 To learn more about the benefits of implementing a Safe Mobility Program at your facility, contact us.*

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*Note, not all services mentioned are available in all regions. 

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References:
1. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treaatment of Pressure Ulcers /Injuries: Clinical Practice Guideline. The International Guideline. Emily Haseler (ed.). EPUAP/NPIAP/PPPIA:2019.
2. Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology, 81(4), 881-890.
3. Pieper, B. (2012). Pressure ulcers: prevalence, incidence, and implications for the future. National Pressure Ulcer Advisory Panel.
4.Padula, W. V., Mishra, M. K., Makic, M. B. F., & Sullivan, P. W. (2011). Improving the quality of pressure ulcer care with prevention: a cost-effectiveness analysis. Medical care, 385-392.
5. Young, D. L., Shen, J. J., Estocado, N., & Landers, M. R. (2012). Financial impact of improved pressure ulcer staging in the acute hospital with use of a new tool, the NE1 Wound Assessment Tool. Advances in skin & wound care, 25(4), 158-166.
6. Berlowitz, D., VanDeusen Lukas, C., Parker, V., Niederhauser, A., Silver, J., Logan, C., & Ayello, E. (2011). Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Agency for Healthcare Research and Quality.
7. Smith, S., Snyder, A., McMahon Jr, L. F., Petersen, L., & Meddings, J. (2018). Success in hospital-acquired pressure ulcer prevention: a tale in two data sets. Health Affairs, 37(11), 1787-1796.
8. Bennett, R. G., O’Sullivan, J., DeVito, E. M., & Remsburg, R. (2000). The increasing medical malpractice risk related to pressure ulcers in the United States. Journal of the American Geriatrics Society, 48(1), 73-81.
9.Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, D. R. (2012). Hospital‐acquired pressure ulcers: results from the national Medicare patient safety monitoring system study. Journal of the American Geriatrics Society, 60(9), 1603-1608.
10. Houghton, P. E., & Campbell, K. (2013). Canadian best practice guidelines for the prevention and management of pressure ulcers in people with Spinal Cord Injury: a resource handbook for clinicians. Ontario Neurotrauma Foundation.

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