If most pressure injuries are preventable, why do so many occur?

Determining where and why gaps in care are happening

Although most hospital-acquired pressure injuries (or pressure ulcers) are reasonably preventable, in the U.S., about 2.5 million acute care patients develop a pressure injury each year.¹ Pressure injuries affect patients’ quality of life, impede rehabilitation and increase length of stay in the hospital – and a single episode can cost a hospital from $500 to upwards of $70,000.¹

A comprehensive review of the pathophysiology and risk factors underlying the development of pressure injuries identifies insufficient staffing as one of the most persistent barriers to prevention.² Another study found that, in addition to staffing and time constraints, staffs’ lack of knowledge of pressure injury stages, causes and prevention can play a role.³

It stands to reason that when staffing and time are limited, it might be hard for nurses to perform routine skin checks and repositioning. It might also be challenging for clinical leaders to systematically deliver pressure injury prevention education. Further, because pressure injury prevention is complex and multidimensional, it can be difficult to pinpoint where and why compliance gaps are happening, and to coordinate multidisciplinary quality improvement initiatives.

Following the problem, getting to the root cause

If pressure ulcer prevention is a challenge in your facility, we can help.

We offer an approach to partnership that is consultative, clinically centered, data driven and anchored in a consistent methodology based on years of supporting clinical research and protocol formation. It includes products designed to minimize steps, simplify workflows, help standardize care and deliver financial outcomes. Equally important, the products are backed by support for your team education efforts, and ongoing measurement and communication of how the products are performing.

We start by understanding your protocols and current practice and by helping you identify clinical outcome trends and hidden costs. It’s sleuth work. We collaborate with your teams across disciplines to identify barriers to protocol compliance, uncover your biggest challenges and get down to the root causes. Then, incrementally, we work to solve the challenges together. We incorporate perspectives from your bedside care providers, data analysts, wound care specialists, supply chain managers – everyone who has a vested interest in doing the right thing for your patients.

Bringing fresh eyes to the care environment, we can often see compliance gaps that people in the thick of patient care workflows might not. As we talk with bedside care providers and watch how they go about their tasks, we’re on the lookout for process variation that might put quality at risk, and opportunities to save workers steps and time.

For example, if you have concerns about protocol compliance when it comes to turning and positioning patients, we’ll take note of things like how long the process takes, if patients are turned at the intervals specified in your protocol, how many team members are involved and if they are performing tasks safely or in a way that could put workers at risk for injury.

Or perhaps you’ve addressed turning and positioning workflow, and now you’re seeing a correlation where patients with severe incontinence are causing pressure injuries to rise. We can review your incontinence care protocols and partner with you to analyze your incontinence-associated dermatitis (IAD) rates and how you're tracking compliance, and to see where process variation may be occurring within your protocol.

Reducing pressure, moisture, sheer and friction

Once we’ve helped coordinate cross-discipline alignment about which gaps to address, we introduce products designed to fit seamlessly with your bedside workflows and to adhere to recognized industry guidance.

When it comes to addressing patient repositioning and mobilization, the National Pressure Injury Advisory Panel’s list of pressure injury prevention points includes guidance to turn the patient into a 30-degree side lying position to lift the sacrum off the bed.⁴ Our Sage Prevalon AirTAP Patient Repositioning Systems can assist you in safely meeting this prevention point, and others related to addressing pressure, moisture, shear and friction.

A 2016 comparison cohort study compared the standard of care (SOC) approach of repositioning a patient with pillows to the use of our patient positioning system.⁵

On average, the SOC approach took 1.97 staff members and achieved only a 20-degree turn, while using our patient positioning system took on average 1.35 staff members and achieved a 30-degree turn – and patients in the SOC group required significantly more repositioning. The study found a statistically significant difference in the occurrence of hospital acquired pressure injuries between the groups (six vs. one).

With respect to skin care, incontinence promotes maceration of the skin and can serve as a precursor to full-thickness pressure injuries if not addressed promptly.² This is why a patient’s skin should be effectively cleaned and protected every time they have an incontinent episode. The Global IAD Expert Panel has created guidelines for an incontinence care protocol that includes using a cleanser, moisturizer and barrier. If a facility has a different product for each of those requirements, process variation and workflow complexity can make it hard to ensure protocol compliance for every patient, every time. What’s more, using an opaque medical barrier cream like zinc oxide can make it difficult to check skin for deterioration.

Our Sage Comfort Shield Barrier Cream Cloths help you apply an effective barrier every time. Each cloth delivers all-in-one skin cleansing, moisturizing, deodorizing, treatment and barrier protection through a breathable, transparent 3% dimethicone formula.*

Driving clinical outcomes

A 500+ bed hospital system was using pillows, foam wedges and draw sheets to turn and position patients in seven ICUs. In one year after implementation, AirTAP helped to reduce sacral pressure injuries by 61% (from 23 to 9), additional ICU days by 61% (from 502 to 197) and patient handling injuries to workers by 50% (from 4 to 2).**⁶

A two-phase evaluation of 86 patients at high risk for developing IAD and hospital-acquired pressure injuries (HAPI) at one hospital in 2015 found that no IAD or HAPI occurred in those who received an intervention that standardized cleanup with a barrier-impregnated cloth following each incontinent episode.**⁷

Supporting sustainable change

Pressure injury prevention is complex and multidimensional; we are here to help you drive protocol compliance and sustainable change by collaborating across your teams to:

• Review your protocols, current practices and challenges
• Identify outcome trends and hidden costs to help you make the case for change
• Align products to workflows
• Support ongoing staff education and competency
• Quantify outcomes to help you secure support from executive leadership

Learn more

Stryker is one of the world's leading medical technology companies. Alongside our customers around the world, we impact more than 150 million patients annually. To learn more about AirTAP, visit Sage Prevalon AirTAP Patient Repositioning System | Stryker. To learn more about Comfort Shield Barrier Cream Cloths, visit Sage Comfort Shield Barrier Cream Cloths | Stryker.