Pressure Points

Pressure ulcers are everywhere. They can be found at every patient age, in conjunction with a myriad of comorbidities, and in every health care setting. They can occur despite exquisite precautions. Their mechanisms of development (top down, bottom up?) continue to be explored and debated, but on one point clinicians and researchers agree: Increased knowledge and understanding are crucial to prevention and intervention when pressure on skin and tissue is a consideration.

The Association for the Advancement of Wound Care (AAWC) is honing in on this specific topic to keep clinicians and caregivers abreast of what we know and sometimes what we don’t know about pressure-related skin breakdown. The AAWC’s first pressure ulcer meeting  — the PrU Summit, a 2-day event featuring many of the movers-and-shakers in the pressure ulcer world — held February 9 and 10, 2018, in Atlanta (GA), provided presentations on the importance of bringing evidence-based research to the bedside; the need to develop international research opportunities; the factors involved in pressure-induced tissue damage; the role of quality metrics in validating tissue damage; opportunities for enhancing pressure ulcer risk assessment, including biophysical measures, alternative tools, and more uniform language; and ways to overcome barriers to translating theories into practice, as well as a session dedicated to attendee queries and concerns. The overarching theme of the conference was that pressure ulcer nomenclature, staging, prevention, and management should be dictated by sound, scientific evidence.

February has become the go-to month for meetings and conferences on the subject; the February issue of Ostomy Wound Management has for years been dedicated to pressure ulcer management. This issue’s features add to the compendium of research and include a review of the factors affecting pressure ulcer healing, 2 articles that discuss novel approaches to care, and an interesting consideration of the role of seasons in pressure ulcer development. The randomized, controlled clinical study by Polak et al demonstrated the effect of 2 types of electrical stimulation (ES) on periwound skin blood flow and showed both anodal and cathodal ES can have a positive impact on subsequent pressure ulcer healing. Karahan et al retrospectively studied data on patients with pressure ulcers whose records included use of the Bates-Jensen Wound Assessment Tool to determine factors that affect wound healing; the results underscored the value of the Bates-Jensen and Braden instruments for pressure ulcer assessment and risk. In a rather unique but logical finding, Chen et al discovered a seasonal effect brought about by higher temperature and humidity on pressure injury incidence. Wang et al raised a flap about improving sacral pressure ulcer resolution that involved surgical closure. 

Whether you use the term pressure ulcer or pressure injury, awareness is key — awareness of the research available and awareness of the importance of using that research to affect policy and protocol change. From your youngest and oldest patients with fragile skin who may need extra protection from (for example) medical devices; to your mobility-compromised patients who may need extra attention to repositioning and support surfaces and pressure distribution; to your patients whose comorbidities must be addressed before healing can commence; to the conditions in your facility that can interfere with effective management, your antenna need to be raised. The information is out there in conferences, on the web, and certainly in OWM; articles on pressure ulcers continue to rank as OWM’s most-read publications.

Meanwhile, make sure you are part of your facility’s or organization’s efforts to proliferate evidence-based management of pressure, including making not only clinicians and caregivers but also patients cognizant of pressure ulcer risk where appropriate. Another point: document your efforts. Protecting someone’s bottom from harm also could save yours, if you get my point.

Make it a point to point out potential problems and make points all around by offering specific suggestions on lowering/alleviating risk. Putting a little pressure on yourself to learn and utilize all you can about pressure ulcers can take the pressure off those in your care. 

This article was not subject to the Ostomy Wound Management peer-review process.