Why Awareness is Key to Preventing Pressure Injury

Dr. Joyce Black:

I'm Joyce Black. I come from Omaha, Nebraska where I work for the University of Nebraska Medical Center as a nursing instructor. I also am the current president of the National Pressure Injury Advisory Panel. That's a group, for the people who don't know, that's a group that's been around 35 years this year, focused totally on pressure injuries.

I present on pressure injuries fairly often, and I think they're a fairly poorly understood wound. I think a lot of doctors focus on venous like ulcers, diabetic foot ulcers, those kinds of things, and they leave pressure ulcer prevention, pressure injury prevention to nurses. And for that reason, no, they sort of don't step into our field. So whenever I'm asked to speak on pressure injuries, I jump at the chance because I hope, as an educator, if I can bring one more person around to understand how to prevent these, that's hundreds less we'll have. So important topic, I think.

Some pressure injuries are truly avoidable, and that's, to me, where the word error comes in. Just as a sidebar, not all pressure injuries are preventable. So in that case, there is no error at all. They happened despite all that we did. The errors, if I can call them that, are probably not appreciating how simple it is to reduce the risk. So pressure injuries form for two reasons: the intensity of the pressure's too high, so somebody who's found down unconscious on the street, or the duration of exposure to pressure's too long. We just have to fix one of those two. So we either have to put them on the right mattress or we have to turn them and turn them well, so get their butt off the bed. That's the simplest way. And I think of all the things that don't get done well, it's those two. It's getting the right bed and getting them turned.

So just as a case, we have a lot of people today that are in the hospital and we know that people get better once they're out of bed. So the doctors will order the patient to be up out of bed and it gets mistaken to be continuously up out of bed. So I equate that to flying from here to Australia without ever getting out of your chair on the plane. Too many hours, Naugahyde seat in a hospital chair, and we see a lot of wounds from that. So going back to my original of the intensity of pressure and the duration, you got to fix one of the two, and that's probably the most common error.

The session today, I'm using an old etiology curve. It was done in 1961, which I'm sure most people in the audience weren't even born in 1961. But what Dr. Koziak said is that it only takes a short amount of time to get a pressure ulcer if the pressure's high, and it'll take a longer period of time to get a pressure injury if the pressures are low. And so I use that curve to sort of set the basis of today's talk.

And then what I did, because we hear this a lot, we hear a lot about, "Oh, the patient has circulatory disease," or, "The patient has diabetes. Isn't that the cause of the pressure injury?" And my answer is no. They're called pressure injuries because they're from pressure. But what those diseases do, it's reduced the tolerance of tissue for pressure. So I took the same curve from Dr. Koziak and drew an arrow on it pointing to the left going, it's going to take less pressure and less time in patients who have diseases that alter tolerance. That's really the big take home message for today.

I think one of the areas that we really need research in is based a lot on the current shortage of nurses. Ever since Covid, we have not had nurses return to the hospital to work. Many of them have gone into the outpatient setting. So hospitals are remaining horridly short of staff. So the question becomes, how can we accomplish the same work with fewer people? So using my same curve, we don't have the time to work on turning. Well, we used to walk around and say people needed to be turned every two hours. Well, we know that's not true. So we need to change that timeframe to every three hours, and we need to improve the mattresses because we just don't have the time to get to that.

So the research that's needed is to prove my point, am I making up stuff or is it real? And if we had research that said yes on the right mattress, turning every three hours is perfectly safe. We have that research in long-term care. We don't have exactly that work in acute care, and I think that's where most pressure injuries start. So those people who are listening to this that are researchers, have at it. Get started. We need it.