Need evidence skin injuries are a major concern in healthcare? Consider that 2.5 million U.S. patients are afflicted annually.
According to the federal Agency for Healthcare Research and Quality, the cost of skin injuries is more than $9.1 billion each year.
The price is even higher, AHRQ reports, because 17,000 lawsuits related to hospital-acquired pressure ulcers are filed each year, second only to wrongful-death suits.
“Skin injuries are extremely prevalent,” said Pamela Damron, MSN, RN, CWON, who has been a certified wound and ostomy nurse for more than two decades. “The cost is very hard on a healthcare system. Patients are coming into the hospital much sicker than they were years ago. They’re already at risk for so many things, and most every patient has two or more comorbidities. And to Medicare, pressure injuries are preventable.”
Damron is the featured presenter of our popular CE webinar course, “It’s Just a Stage 1 Pressure Injury. Or Is It?” She has been a certified wound-ostomy nurse since 1998 and is a nursing instructor at the University of Tennessee Martin.
The 1-hour recorded CE webinar is accredited for nurses, physical therapists, occupational therapists, pharmacists and dietitians/nutritionists.
Here are five ways to ensure you and your team are delivering the highest quality of patient skin care.
#1 — Healthcare is a team sport
This phrase is especially true with pressure injuries and wounds.
“Every discipline has something unique to add to the care team,” said Damron, who encourages all members of a care team to be involved with patients. “The approach of an interdisciplinary team is really the only way a patient can get a holistic approach. As nurses, we look at one picture, and everyone has expertise to look at from their perspective. It takes an overall, multidisciplinary team to look at the whole picture.”
Nurses play a key role at the forefront of care. CWONs use their expertise to assess and treat wounds and ostomies.
PTs encourage ambulation and proper positioning of patients, along with promoting optimal function.
Pharmacists have the ability to examine a patient’s in-hospital and home medications for interactions, communicate with physicians and encourage any changes in medications.
OTs assist with patient transfers and re-positioning while providing helpful resources and equipment recommendations.
Registered dietitians and nutritionists assist in wound healing by performing a thorough nutritional assessment, looking for signs of malnutrition or other dietary deficiencies. This assessment determines nutrition needs that can aid in the healing process.
#2 — Look from head to toe
Re-positioning patients every two hours is a high priority to avoid pressure injuries, Damron said. The need to examine potential problem areas of the body also is a necessity for healthcare clinicians.
Some areas are ones clinicians may not expect or regularly check. “Especially in the ICU, we see a lot of places on the back of the head,” she said. “I would have never thought about that when I first got into wound and ostomy care.”
Heels, hips, elbows and tailbone often are concerns. For patients who prefer to lie on their sides, Damron said clinicians should monitor shoulders, knees, ankles and ears. For patients on oxygen or who use a CPAP machine, the nose and cheeks — where a mask fits tightly on the face — are common trouble areas.
#3 — Document, document, document
Hospital-acquired pressure injuries are among the conditions considered preventable by the Centers for Medicaid and Medicare Services. Thus, healthcare facilities are not reimbursed for treating these injuries when they are acquired by a patient in the hospital.
A thorough skin assessment “is very important when a patient arrives,” Damron said. This protects a healthcare facility from potential litigation and also serves as a baseline for caring for the patient.
“That assessment is critical to the healthcare system and the patient,” she said. “If the facility doesn’t document these injuries in the first 24 hours, we are legally liable from Medicare.”
A full assessment early in a patient’s stay offers other benefits, too.
“We can immediately get the interdisciplinary team involved,” Damron continued. “If we didn’t know the patient was at high risk and we let that go, that’s where we get into legal complications, and the patient suffers, as well.”
#4 — Consider where patients are going/coming from
Knowing the path your patients take during their hospital stay can offer helpful clues, Damron said. For example, a patient who spends hours in surgery or getting tests such as an MRI, x-ray or CT scan all will be lying for long periods on hard surfaces. This leads to a greater risk for pressure injuries.
In addition, patients who are unconscious, anesthetized, paralyzed, sedated or have neuropathy all have an increased pressure injury risk.
This is where OTs are important in the care plan. “An OT can come in and assist with transfers, re-positioning and offer good resources for the patient,” she said.
#5 — Start with a smile
For Damron, learning about a patient begins when entering a room. “You can tell a lot just by smiling at them,” she said.
A return smile from a patient can be the start of a nurse’s education. Smiling shows a nurse if a patient has dentures, a full set of teeth or very few teeth.
Does a patient have jaundiced, dry or moist skin? Are bags under the eyes present that could signal a patient isn’t getting enough rest?
Noticing these signals right away is the beginning of a good assessment.
“I try to put myself in their situation,” Damron said. “I always ask about their day. My goal with every patient is to have them smile before I’ve left the room.”
Damron also learns from patients who don’t smile, make eye contact or speak to her. These could be signs of depression, mental challenges or cultural differences.
“If they don’t make eye contact, then I know something’s definitely wrong,” she said.
To learn more about the many facets of pressure injuries and their treatment, watch Damron’s presentation in our webinar, “It’s Just a Stage 1 Pressure Injury. Or Is It?”
Take these courses related to maintaining patients’ skin integrity:
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