Controlling costs, improving patient safety, and managing staff shortages are top-of-the-mind concerns for healthcare executives in 2023. Implementing an effective pressure injury prevention program can help you address all three concerns.
The True Cost of Pressure Injuries
According to the National Pressure Injury Advisory Panel, healthcare systems in the United States spend approximately $26 billion dollars annually on pressure injuries, or localized damage to the skin and underlying soft tissue. Pressure injuries are the most common preventable healthcare events, and patients with hospital-acquired pressure injuries require an average of 4.3 more days of hospitalization than similar patients who do not develop pressure injuries. Medicare and Medicaid will not pay for additional costs incurred for hospital-acquired pressure injuries.
Because pressure injuries cause pain and discomfort and increase patient susceptibility to infection, pressure injuries (sometimes also called pressure ulcers, pressure sores, bedsores, or decubitus ulcers) increase nurse workloads. These injuries must be assessed regularly; appropriate assessment and wound care, including dressing changes, are time-consuming.
Simply moving and repositioning patients with pressure injuries takes extra time, as extra care is needed to prevent further damage. According to a 2020 systematic review and meta-analysis published in the International Journal of Preventive Medicine, pressure ulcers “cause the nursing staff an increase in workload by 50%.”
Yet pressure injuries remain incredibly common. It’s difficult to assess the true frequency of pressure injuries; however, studies suggest that as many as 40 percent of hospitalized patients develop at least one pressure injury. Rates are highest among seriously ill patients and those admitted to intensive care or orthopedic surgery units because these patients are physiologically more vulnerable to pressure-related injuries.
The patient care cost per pressure injury ranges from $20,900 to $151,700 according to the National Pressure Injury Advisory Panel. The true human cost of pressure injuries, however, is almost impossible to quantify. Approximately 60,000 patients in the United States die as a direct result of a pressure injury each year.
How Pressure Injuries Develop
Pressure injuries occur when pressure decreases blood flow to a particular area of the body for a prolonged period. Because blood carries essential oxygen to the cells, a decrease in blood flow decreases the cells’ oxygen supply. Without sufficient oxygen, cells can die.
If you lay on your side for an extended period of time, you may develop a slightly reddened area over your hip bone. That slight redness is a very early-stage pressure injury; in that particular position, your body weight exerts pressure on that area, interrupting blood flow. If you’re in good health, your blood flow will return to normal when you get up and move around and the redness will dissipate. Hospitalized patients, of course, aren’t able to move around as much as they usually do.
If the pressure is not relieved (and circulation restored), a sore (or ulceration) can develop. Without treatment or intervention, pressure injuries typically get worse over time. Severe pressure injuries can extend to the muscle or bone – and may take weeks or months to heal, even with excellent medical and nursing care.
Pressure Injury Prevention
Evidence-based nursing practice can prevent the development of pressure injuries, according to the Joint Commission. Best practices to prevent pressure injuries include:
- Regular skin assessments
- Regular re-positioning
- Routine skin care, including prompt skin cleaning after episodes of incontinence
- Nutritional support
- Use of pressure-relieving devices, including alternating pressure cushions for wheelchairs and specialized beds and mattresses
Regular nurse rounding gives nursing staff an opportunity to implement these interventions – and evidence shows that focused rounding can effectively decrease pressure injuries. After a 17-bed surgical intensive care unit instituted peer-to-peer bedside skin rounds, the unit’s hospital-acquired pressure injury prevalence rate decreased from 27% to 0% for three consecutive quarters.
Automated nurse rounding technology can help staff develop (and sustain) a regular rounding habit. The SwipeSense Nursing Insights application and SwipeSense Rounding Monitor deliver data that clinical staff can use to adjust their practice and workflow to proactively meet patient needs. And proactively meeting patient needs via purposeful hourly rounding is associated with a bevy of benefits for both patients and nurses, including an average 14% decrease in skin breakdown and pressure injuries.
Sustained use of evidence-based pressure injury prevention strategies, including hourly rounding to assess, reposition, and provide skin care to patients, can decrease pressure injuries and promote patient safety while easing nurse workloads.