Karen Lerner

Caregiver fatigue and not having proper support contributes to the quality of care she/he is able to provide. Before anyone ever heard of COVID-19, most heard whispers of a nursing shortage. As our nation ramps up to care for the surge of COVID-19 patients, staffing shortages will exacerbate, especially among staff equipped to care for highly acute patients. And will only become more severe as staff inevitably fall ill and become patients themselves.

Preventing pressure injuries has always been a challenge for our health care industry and for caregivers. Aside from the high cost of treatment, pressure injuries have a great and negative impact on patients’ lives. The development of pressure ulcers or injuries can interfere with patients’ functional recovery, is often complicated by pain and infection and can contribute to longer hospital stays. Furthermore, the presence of pressure injuries is a marker of poor overall prognosis and may contribute to premature mortality.1

Pressure injuries are commonly seen in high-risk populations, such as the elderly; those requiring ventilators; and those who are very ill. Critical or intensive care patients are always at heightened risk for pressure injury development because of hemodynamic instability, increased use of devices and the use of vasoactive drugs. Since 2008, the Centers for Medicare and Medicaid Services (CMS) stopped paying for additional costs incurred for hospital-acquired pressure injuries because the development of pressure injuries can be prevented: with a comprehensive pressure injury prevention and treatment plan which includes an off-loading or pressure redistribution bed and seated support surface.

Preventing pressure injuries is incredibly resource and time intensive. Every patient must be given a comprehensive skin assessment, not once, but repeatedly throughout their stay. For patients who are at risk for or have a pressure injury, a myriad of interventions is recommended such as regularly off-loading the patient in their bed or chair, applying dressings to body bony prominences and changing their meals to enhance proper nutrition.

Pressure relieving and redistributing devices are widely accepted methods of trying to prevent and help treat pressure injuries. The devices used include different types of mattresses, overlays, cushions and seating. These devices work by reducing or redistributing pressure, friction or shearing forces; and helping control the microclimate at the skin/mattress interface. 2

Proper selection of a support surface depends on factors such as mobility of the individual, the results of skin assessment, the level of and site at risk, weight, staff availability and skill plus the general health and condition of the individual. It is also important that any device can be cleaned and decontaminated effectively. It is accepted that these devices should be used in conjunction with other preventative strategies such as repositioning. 2 Help prevent pressure injuries during our world pandemic by issuing a specialized pressure redistribution bed and seated support surface for every patient at risk for or with a pressure injury.

1 https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission-online/quick_safety_issue_25_july_20161pdf.pdf?db=web&hash=A8BF4B1E486A6A67DD5210A2F36E0180

2 https://www.ncbi.nlm.nih.gov/books/NBK333135/

Karen Lerner, RN, MSN, ATP, CWS, is regional VP, Clinical, at Drive DeVilbiss Healthcare.