Healthcare facilities across the country have made pressure injury prevention an essential part of their operations3 — and yet the challenge remains.
Human and economic costs
For patients, HAPIs mean more pain, longer stays in healthcare facilities and greater recovery costs. But it would be a mistake to dismiss pressure injuries as a little extra discomfort. While the majority of patients recover from complications, approximately 60,000 people in the United States die each year4 as a result of preventable pressure injuries.
Hospitals bear costs of their own. The average financial burden of a HAPI is $21,784 and they increase both the number of bed days (by 9.5 days) and the rate of readmissions.5 In 2019, the economic impact of HAPIs was $9 billion — more than surgical site infections, falls, CAUTIs, DVTs, VAP, CDIs, and CLASBIs combined.2
Indirect costs of pressure injuries include reduced quality metrics; damaged reputations; fines, penalties and litigation; and the need to utilize additional resources.6 With such a range of consequences both for patients and providers, it is important for healthcare facilities to continue exploring evidence-based approaches to solving the problem of pressure injuries.
New practices and protocols
The National Pressure Injury Advisory Panel recently developed and released guidelines to help facilities reinforce pressure injury prevention.7 These guidelines can help strengthen practices and protocols that lead to better clinical outcomes. Education, nutrition, repositioning, mobilization and skin care are all recommended. Different combinations of these activities may be appropriate for patients with different levels of risk,8 and they may also differ depending on the setting and hospital unit.
No matter how these protocols are bundled, it is worth noting that there are also products on the market that can play a significant role in a facility’s pressure injury prevention efforts. In particular, products that facilitate patient repositioning and redistribute pressure have been shown to significantly reduce the risk of patients developing HAPIs.
Patient repositioning
Failure to adhere to patient repositioning protocols exposes healthcare facilities to a host of risks. Unfortunately, a recent study found the average compliance with turning protocols ranges between only 40%–70%.9-12 Variability in care is also apparent based on the time of day, as well as, gender and BMI lines.13 It is clear that there are improvements to be made.
Fortunately, products like the LEAF◊ Patient Monitoring System (developed by Smith+Nephew) are available to help improve adherence to repositioning protocols.
The LEAF Patient Monitoring System is a wireless, wearable sensor that allows care staff to coordinate individualized turn protocols for their patients. The first of its kind, this system optimizes patient repositioning with its proprietary Integrated Positioning IndexTM. This enables the sensor to transmit information about turn frequency, turn angle, and recovery time to facility computers so that nurses can identify and prioritize who needs to be turned and when.
Patient Monitoring Systems have a range of clinical benefits. In one study, the LEAF System increased average adherence from 48% to 92%.10 The study also showed a significant reduction in turning compliance variability after intervention. With adherence rates such as these, the LEAF System is able to reduce the incidence of HAPIs by 73%.14
It is clear that facilities that integrate these types of sensors into their protocols can make major strides in their pressure injury prevention efforts.
Prophylactic dressings
When it comes to HAPIs, the use of prophylactic dressings can also go a long way in preventing pressure injuries. If pressure injuries result from friction between a patient’s skin and another surface, it makes sense that placing a soft layer between the two surfaces can help.
But there are more factors to consider than what is apparent at a glance. Temperature, moisture, and the pH of surface skin must be carefully managed to ensure the most successful outcome.15 There are also economic considerations. While prophylactic dressings are generally regarded as inexpensive, accessible and easy to use,16 some dressings have relatively short wear times and must be changed frequently. This costs facilities both money and time.
An example of a prophylactic dressing that is both clinically effective and cost efficient is the ALLEVYN◊ LIFE Foam Dressing. This dressing has a unique, 5-layer construction that absorbs fluids and redistributes pressure over a larger contact area than traditional dressings.14
With multiple shapes and sizes available, nurses are able to deploy dressings that are designed to fit specific body contours like the heel or sacrum. In addition to its absorbent and protective layers, ALLEVYN dressings also have an innovative EXUMASK◊ Change Indicator that helps visualize when it is time to change to a fresh dressing.10, 17, 18
In practice, ALLEVYN◊ LIFE foam dressings can be worn up to 7 days19, which is twice as long as the wear time of traditional dressings.20 In one study, the time saved in reducing the number of dressing changes was shown to release 397 hours for nursing staff per week,21 leading to per-patient cost savings of up to 69%.22-23
On the clinical side, the use of ALLEVYN LIFE dressings resulted in a 71% reduction in the incidence of sacral pressure injuries,22 and the similar ALLEVYN Gentle Border dressings resulted in a 90% relative reduction in pressure injuries compared to standard preventative care alone.24
Pressure inventory prevention
Every hospital needs to assess which protocols are most appropriate for their facilities and their patients. The effectiveness of even the best practices, protocols and products can be limited by a variety of constraints that are not always within a facility’s control. But having an awareness of the latest clinical guidelines for the prevention of pressure injuries is an essential part of any strategy.
Armed with this knowledge, decisionmakers can identify the most cost-effective solutions for preventing HAPIs. For some hospitals that might mean prioritizing patient repositioning with the LEAF◊ Patient Monitoring System to improve turning compliance. For others it might mean integrating Smith+Nephew’s prophylactic ALLEVYN LIFE Foam Dressings to redistribute pressure and maximize wear time. Others still may find that adding both interventions to their inventory works best.
By combining proper practices and protocols with innovative products, hospital staff have the best chance of making a positive impact on both their facilities and their patients.
References
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2 National Scorecard on Hospital-Acquired Conditions, Agency for Healthcare Research and Quality (AHRQ). June 2019. Accessed November, 2019 at AHRQ National Scorecard on Hospital-Acquired Conditions Updated Baseline Rates and Preliminary Results 2014-2017.
3 Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Advances in Patient Safety. Rockville (MD)2008.
4 Agency for Healthcare Research and Quality website. Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html. Updated October 2014. Accessed June 20, 2017.
5 Wassel C et al. Poster presented at SAWC Fall 2019 Conference; Las Vegas, NV, USA. Oct 12-15, 2019. 2. Dreyfus J et al. Am J Med Qual. 2018;33(4):348-358.
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7 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA: 2019.
8 Padula WV, Pronovost PJ, Makic MBF, Wald HL, Moran D, Mishra MK, et al. Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis. BMJ Qual Saf. 2019;28(2):132-41.
9 Lin F, Wu Z, Song B, Coyer F, Chaboyer W. The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review. Int J Nurs Stud. 2020;102:103483.
10 Schutt SC, Tarver C, Pezzani M. Pilot study: Assessing the effect of continual position monitoring technology on compliance with patient turning protocols. Nurs Open. 2018;5(1):21-8.
11 Turmell M, Cooley A, Yap TL, Alderden J, Sabol VK, Lin JA, et al. Improving Pressure Injury Prevention by Using Wearable Sensors to Cue Critical Care Patient Repositioning. Am J Crit Care. 2022;31(4):295-305.
12 Maguire J, Hastings D, Adams M, Phillips D, McKenna J, Lin JR, et al. Development and Implementation of an Individualized Turning Program for Pressure Injury Prevention Using Sensor Technology in Nursing Homes: A Quality Improvement Program. Wound Manag Prev. 2021;67(11):12-25.
13 Pickham et al. Pressure injury prevention practices in the Intensive Care Unit: Real-world data captured by a wearable patient sensor. WOUNDS, August 2018.
14 Pickham D et al. Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). Int J Nurs Stud. 2018 Apr;80:12-19. doi: 10.1016/j.ijnurstu.2017.12.012. Epub 2017 Dec 30.
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16 Cornish L. The use of prophylactic dressings in the prevention of pressure ulcers: a literature review. Br J Community Nurs. 2017;22(Sup6):S26-S32.
17 Data on File Report DS/15/025/R – May 2016, L. Daubney. Physical Testing ALLEVYN LIFE Gen2.
18 SECURA Protective Ointment [Instructions for Use].
19 Rogers M. Reducing Hospital-Acquired Pressure Injuries (HAPI) in Long-term Acute Care with Turn Cueing Technology. Poster presented at AONL 2020.
20 Joy H et al. A collaborative project to enhance efficiency through dressing change practice. Journal of Wound Care. Vol 24. No 7. July 2015 P3-4.
21 Data on File Report DS/15/217/R – October 2015, L. Daubney. Pressure Transmission Testing.
22 Forni C, Searle R. Economic evaluation of the use of a multi-layer polyurethane foam dressing for the prevention of pressure ulcers in elderly patients with hip fractures. Poster presented at EPUAP annual meeting, September 2018.
23 Forni C, D’Alessandro F, Gallerani P, et al. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial. Int Wound J. 2018; 15(3):383-390.
24 Lee YJ, Kim JY, Shin WY, Yeon YH. Use of prophylactic silicone adhesive dressings for maintaining skin integrity in intensive care unit patients: A randomised controlled trial. Int Wound J. 2019;16(Suppl. 1): 36–42. https://doi.org/10. 1111/iwj.13028.
