Nursing Care?

About 1.2 million cases of hospital-acquired pressure ulcers occurred in 2015. That reflected a rate of about 36 per 1,000 discharges, a decrease over the 2010 rate of 40 per 1,000 discharges. (Source: AHRQ, 2017 National Healthcare Quality and Disparities Report, Chartbook on Patient Safety).This statistic makes my rehab nurse blood run cold! Pressure ulcers are preventable and clearly fall within the purview of nursing care. When patients are admitted to the hospital in any diminished capacity to move independently, their skin surfaces should be part of a complete assessment. This assessment is also needed for patients who become diminished during a hospital stay due to surgery, deterioration, or sedation. Additionally, those patients prone to skin breakdown should have routine skin inspection on each shift, particularly over bony areas and skin folds. Nurses need to consider mobility, bed surfaces, nutritional status and mental status in preventing patient skin breakdown. Care needs to be taken to avoid friction or shearing of skin during transfers and turning/repositioning. A schedule of turning and repositioning an immobilized patient needs to be implemented every two hours including through the night.

Once a skin breakdown happens, it becomes a site for infection, formation of deeper tissue involvement and a major complication on top of what ever the patient’s diagnosis was to begin with. Skin care is basic but, in the world of high tech medicine, some basics get lost in translation. Though I am glad to see that the rate of pressure ulcers has dropped, it is still a problem that creates suffering, prolongs inpatient care and is costly across the board. We can and should do better.

To your Success!