Prevention and Management of Pressure Injuries

By: Suzan Miller-Hoover DNP, RN, CCNS, CCRN-K

Surviving StrokeDid you know that the National Pressure Ulcer Advisory Panel (NPUAP) recently changed the name of pressure ulcers to pressure injuries? Historically, the belief was that to incur a “bedsore/decubitis ulcer” one had to be bedridden. However, healthcare workers now recognize that pressure injuries can occur whenever the patient constantly maintains any position. Additional factors such as incontinence, poor nutrition, and immobility can contribute to tissue injury (NPUAP, 2016 & 2016a). Additionally, many injuries are not ulcerative, especially when they are just developing.

In addition, the NPUAP changed the definition of pressure injuries to include medical device pressure injury and mucosal membrane pressure injury. These additions support the myriad of evidence discovered in the recent past (NPUAP, 2016 & 2016a).

Based on the evidence and consensus of experts, the Wound, Ostomy, and Continence Nurses Society (WOCN), updated the 2008 guidelines for the prevention and management of pressure ulcers/injury. These updated guidelines were published in 2016. These new guidelines embrace the evidence published by the NPUAP. These guidelines identify the management goals and the steps to take to meet these goals.

These guidelines support the use of a valid/reliable risk assessment tool for the population you are working with. The frequency of use for these tools remain dependent on the type of facility the patient is in and the acuity of the patient. It is important to know that these recommendations may not match the frequency recommended by the accrediting bodies, so be sure you know the policy of your facility (Wound, Ostomy, and Continence Nurses Society (WOCN), 2016).

As in the past, prevention is the gold standard; however, pressure injuries cannot not be eliminated in all cases due to the patient’s condition and the microclimate he/she is in. Therefore, prudent healthcare workers will assess and reassess their patients frequently to help ensure early identification and early treatment of pressure injuries.

To learn more about the changes and what you can do to prevent and manage pressure injuries go to RN.com and review the Pressure Injury Assessment, Prevention, & Management module.

National Pressure Ulcer Advisory Panel (NPUAP). (2016). NPUAP pressure injury stages. Retrieved from: http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/

NPUAP. (2016a). Pressure injury staging illustrations. Retrieved from: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/

Wound, Ostomy and Continence Nurses Society (WOCN). (2016). Guideline for prevention and management of pressure ulcers (injuries). WOCN clinical practice guidelines series 2. Mt. Laurel, NJ.

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