Pressure Injury: Can We Do Better?

When preventing pressure injuries, numerous strategies are available. These include reducing the intensity of the pressure, reducing the duration of the pressure, reducing the effect of shear, and improving the health of skin. But can wound clinicians do better to prevent pressure injuries? My presentation takes a look at how to improve risk assessment, prevention and treatment.

How can we improve risk assessment of pressure injuries? The Braden Scale is the most common risk assessment scale in use in United States but it is not designed for many patient groups. Prevention plans are based on a total score on this scale but not all risk profiles are the same, and nurses become “risk assessment averse.”

In the critical care setting, improving risk assessment may entail assessing perfusion/oxygenation, the severity of illness, and physiological alterations. In the ICU, clinicians may want to look for perfusion issues, mechanical ventilation, endotracheal tubes or face masks, patients who are too unstable to turn, or patients who are chemically sedated or paralyzed.  

To improve risk assessment for pressure injuries, one should continue with the Braden scale to screen patients for risk, and refine risk assessment with population-specific risk scales or factors. There are several approaches based on level and type of risk: sensory loss, moisture, inactivity, immobility, nutrition, and friction/shear.

Can we do better in treating pressure injuries? My presentation takes a closer look at controlling the cause of the injury, reducing pressure over a pressure injury, improving nutrition and reducing infection. I also look at wound cleansing, reducing infection risk, whether or not to debride pressure injuries, the efficacy of negative pressure wound therapy, and how to improve dressings for pressure injuries.     

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