Wound care riddles remain, despite $11 billion price tag

Janice Beitz
Janice Beitz

There are a lot of questions still swirling around why certain residents develop pressure ulcers, but it's unquestionable  they remain a costly problem for long-term care providers.

“Currently, the best guestimates are that we are spending $11 billion annually on pressure ulcer care,” said Janice Beitz, Ph.D., RN, a professor of nursing at Rutgers University, at McKnight's recent Online Expo.

More research is needed to understand how nutrition, surfaces and the patient's physical make-up play a role in pressure ulcers, added Beitz, a pre-eminent wound educator.

“We have seen patients where we would bet the farm they would break down and they don't, and others where despite everything we do, they still break down,” Beitz said. “The science has not given us enough information.”

What is clear is full lateral positioning is discouraged, and the head of the bed should be cautiously placed. While heel offloading is recommended, many providers are not raising the foot high enough, Beitz said.

“Bunny boots or heel elbow protectors are usually not enough,” she said. “If you are using egg crate foam, it has to be at least 3 to 4 inches thick.”

Moisture on the skin is another area that needs more scrutiny, she said, adding it can “soften the skin and impair it.”

Risk assessment and skin assessment are two different things, she said. The Braden Scale for Predicting Pressure Ulcer Risk should be used.