6 facts about pressure injuries nurses must know

Editor’s note: We have partnered with Wound Care Education Institute raising awareness of the devastating effects of wound care knowledge gaps within the US health care system. Our goal is to teach clinicians in order that they can empower themselves and their organizations to deal with these gaps through wound care education. Whether it’s learning a few recent treatment or product, the various kinds of wounds, and plenty of best practices, physicians keep patients up-to-date with the present standard of care through a solid knowledge base. Managing pressure ulcers is something that many nurses encounter regularly as a consequence of their ubiquity across the healthcare continuum, whether it’s home care, acute care, or long-term care. Don Wollheim, MD, FAPWCA, WCC, DWC, is an American Board of Surgery board-certified surgeon with 25 years of experience usually/vascular surgery and 13 years of experience as a wound care specialist and educator. He is a medical and legal consultant, a university science lecturer, and, amongst others, clinical instructor on the Wound Care Education Institute (WCEI).

Caring for patients with pressure injuries

Wollheim shares six key facts that physicians should know when caring for a patient with pressure injuries.

1 – Pressure injuries are dynamic

Wollheim said care practices of the past will not be the identical as those used today. What is completed today will not be considered best practice in the long run. Simply put, wound care is continually changing. One example is the timing of a Wound assessment using the Braden scale to predict skin damage in patients. “For many years, the practice was to conduct a Braden scale assessment within 24 hours of admission to the facility,” he said. “The new guidelines now call for a Braden risk assessment to be carried out within eight hours of admission. “This is a new standard of care and the result of scientific discoveries that have shown that for some patients 24 hours may be too late because necrotic tissue may show much earlier – and even after six hours, timely administration of the Braden scale and its correct use are essential.” . Another common wound care practice in recent years has been wet-dry dressings. It is now considered obsolete and is no longer considered the standard of care, Wollheim said.

2 — Changes in terminology and documentation

Just as care practices change, so does health care terminology. According to Wollheim, when clinicians care for wound care patients, using current terms is essential to ensure appropriate regimens are required. Pressure injuries were called bedsores or decubitus ulcers. In 2016, the National Advisory Panel on Pressure Injuries recommended changing the name to pressure injuries. Another recent change was the update of the classification system for pressure injuries and their numbering. Roman numerals are no longer used. Wollheim said doctors now use Arabic numerals instead.

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Nurses caring for patients with pressure injuries will want this monitor the speed of wound healing.

“We want the wound to heal as quickly as possible,” he said. “The goal is to reduce wound size by 50% (length and width) within three to four weeks of starting treatment,” Wollheim said.

What if the wound doesn’t heal as quickly as expected? At this point, a change in treatment must be considered.

4 – Use TCOM to predict who is probably going to reply to hyperbaric treatment

A brand new trend in wound treatment is using transcutaneous pulse oximetry, also referred to as TCOM.

“With TCOM you can find out how much oxygen is in the capillaries surrounding the wound bed,” Wollheim said. “Knowing this level is very helpful in determining whether a patient is more likely to respond hyperbaric oxygen therapy or not.”

According to Wollheim, if the TCOM level is 30, there is a good chance that the wound will not heal. However, if the TCOM is 40 or higher, the wound will likely respond to hyperbaric oxygen therapy. According to study published in the American Journal of SurgeryTCOM has been found to be a beneficial tool for predicting which patients will respond best to hyperbaric treatment.

5 – Educate colleagues about wound care

When experienced and certified wound care clinicians encounter an order for the wrong supplies or treatment, or see a colleague practicing an outdated or unproven practice, actively educate them, Wollheim said. “When differences arise, it is best to do so approaching the referring physician or colleague in a non-judgmental and collaborative manner,“You will likely encounter less resistance, and the other person may realize they can learn something from you.” Another reasonably priced method that will help healthcare team members turn into more knowledgeable about wound care is to schedule webinars or lunchtime educational seminars – these sessions can often be led by company representatives on the assorted products utilized in your organization.

“Never underestimate the power of free food,” Wollheim said. “Scheduling a time when everyone can view the file webinar lunch-and-learn is a good way for everyone to learn about the proper use of certain products, procedures and treatments.”

Promoting wound care dialogue can also be achieved through monthly patient care meetings with all wound care specialists. This is another way to encourage dialogue. For example, delegating to doctors, nurses, physiotherapists, dietitians and even support staff may be on hand to work with staff such as:

• Discussion of current treatment methods
• Suggestions if something doesn’t work
• Ensuring that everyone uses the same terminology

6 – Make sure everyone knows how to use new products

Changing from one brand of wound care product to another may require different sets of instructions for use with each new product. “Whenever you change a brand, you have to make sure all employees know how to use the new products,” he said. “This may require a service review to ensure all staff are on the same page and using current products correctly – as the manufacturer intended – to achieve the best outcomes for patients.”