Dr Jeffrey M. Levine MD, AGSF, CMD, CWSP

Q: How can care for pressure injuries be incorporated into a facility’s system of care? 

A: Pressure injuries are a universally recognized quality indicator, meaning that the presence of such a wound implies that something went wrong. The care of pressure injuries is a multidisciplinary endeavor that involves doctors, nurses, CNAs, nutritionists, speech therapists, pharmacists and materials management personnel. It is a process that needs to be incorporated into the facility’s day-to-day activities.  

This concept is actually embedded within the federal regulations that govern nursing homes, which say facilities “should have a system/procedure to assure: assessments are timely and appropriate; interventions are implemented, monitored, and revised as appropriate; and changes in condition are recognized, evaluated, reported to the practitioner, and addressed.”

The commitment to pressure injury care  must come from the top level of administration, with representatives from each discipline gathering information and provide interventions that maximize the efficiency of prevention and treatment. 

Start by gathering wound statistics for a period of time, targeting specific cases where care might have been improved and asking specific questions.

Were the wounds present on admission? Were proper prevention interventions in place and care planned? Were treatment modalities appropriate and timely? Was nutrition properly assessed? Was the family properly informed? Were consultants utilized? All these questions must be honestly addressed for improvement. 

The maintenance of skin integrity for frail residents is a unique challenge for facilities across America. The best way to prevent and heal wounds is to tweak the system to proactively create and maintain a system that delivers maximum quality of care.