Facilities that take the time to train new staff and empower experienced nurses are more likely to catch problematic ulcers before they begin.
Pressure ulcers and the accompanying task of preserving residents' skin integrity are never-ending challenges for long-term care providers.
Not only is the treatment of pressure ulcers lengthy, it also costs an estimated $11 billion per year in the United States, with some $500 to $70,000 spent on each single wound.
Referred to variously as pressure ulcers, pressure sores, decubitus ulcers or wounds, the National Pressure Ulcer Advisory Panel now considers “pressure injury” the best term to use because it “more accurately describes pressure injuries to both intact and ulcerated skin.”
Facilities should consistently use a predictive scale for pressure injuries to identify those at high risk for pressure ulcers, The Society for Post-Acute and Long-Term Care Medicine (AMDA) advises. The organization debuted a set of new pocket guides meant to help with issues such as pressure ulcers in April, along with new “Know-It-All Before You Call” cards that help nursing staff evaluate patients and collect data.
Preventing the occurrence of pressure injuries means taking steps to ensure residents are assessed and evaluated, to determine if they are at high risk of developing an injury, explains Angel McGarrity-Davis, RN, CDONA, NHA, founder of Transitional HealthCare Coordination.
“This means early intervention with proper nutrition, taking into account caloric needs, protein, supplements and vitamins, and fluid needs,” she says. “Successful wound programs that incorporate these elements will improve quality of care, facilitate better five-star ratings, reduce litigation risk, prevent rehospitalizations and reduce facility costs.”
A new twist on treatment
Another vital component of pressure injury prevention is maintaining and preserving skin integrity. McGarrity-Davis says that is best accomplished via an interdisciplinary team that includes a nurse, physician, therapist, dietitian and pharmacist.
“It's important to empower your staff with knowledge about the resident's plan of care and ensure they are competent about dressing changes per federal regulations,” she says.
A recent review of current pressure ulcer research and management, published in the journal Advances in Wound Care, came to similar conclusions with regard to prevention and proactivity. The article states that despite the many new dressings and treatment modalities that have been developed in recent years, “none has demonstrated any clear benefit over the others.”
Confounding the problem are increased rates of obesity, diabetes, and cardiovascular disease, “which in turn has resulted in more people needing assistance with activities of daily living due to decreased mobility,” the authors assert.
While treatment may still be exasperating, basic tenets such as “documenting the details of an observation; paying attention to surrounding tissue, odor, pain, and any drainage; measuring accurately; and using standardized assessment tools such as Braden scale,” remain the hallmarks of therapy, says McGarrity-Davis.
AI and algorithms
Indeed, among some of the newer products and treatments on the market are solutions that range from high-tech, artificial intelligence (AI) and predictive learning treatments to well-worn applications that were once popularly used on infants in hospital nursery units.
In addition, solutions that are aimed at preventing falls, incontinence and urinary tract infections often are also applicable to reducing the risk of pressure injuries. Case in point: Mpower's Rounding Process for Incontinence. Designed to forecast at what time a resident of a skilled nursing facility needs to go to the restroom, an algorithm that is programmed onto a tablet asks the nurse assistant to document for several days each time she assists a resident to a bathroom.
Basic demographics about the resident, such as medications, mealtimes, and diagnoses — 28 different factors in all — are loaded into the program, according to Frank Beech, vice president of Mpower Services.
“The CNA documents when a resident goes to the bathroom, the program learns the individual's voiding patterns, and the algorithm predicts when that person will need to go next,” he says.
More reminiscent of advanced intelligence technology, Beech says the program is “constantly learning” behavior patterns. “After seven days of using the program, it is 75 percent accurate in forecasting when a resident will need to go.”
At Dunwoody Village in Newtown Square, PA, which did a pilot study with MPower, the facility reduced falls by 54% and had a 71% decrease in episodes of incontinence for people who need assistance. Although the program is aimed directly at reducing incontinence, it also claims additional benefits such as fall reduction, reduced wound infections, fewer UTIs, and a decrease in staff time requirements.
New strategies and products
Relatively new to the long-term care market is a treatment that both heals and prevents pressure injuries, according to Roseanna Beneditti, national clinical marketing consultant for RashEndZ, a patented, continuous air/oxygen delivery technology that circulates oxygen within a worn diaper or garment, and within many wound dressings.
Beneditti notes that RashEndZ enables the delivery of something called Dynamic Oxygen Skin Therapy, or DOST.
“It adheres to an undergarment and plugs into the DOST device,” she explains. “It is the most innovative therapy out there now to take care of any kind of wound.”
McGarrity-Davis says she used RashEndZ along with her wound physician and was impressed.
“I've never seen such improvement pretty much overnight on non-healing wounds and fungal infections,” she says. “We then started using it for high-risk residents to ensure there was not going to be any skin breakdown.”
RashEndZ's founder is a former neonatal nurse who wanted to find a solution to issues caused by incontinence in premature babies. It turns out that what worked for babies also works for older adults who are at risk of developing pressure injuries, as well as those who already have them.
Another skin protectant option is called GlideWear. Augustana Care in Minneapolis and Tamarack worked on a pilot program and found success with the fabric technology, which reduces friction and shear forces that contribute to pressure injuries with the goals of faster healing and wound prevention. In the 2016 pilot, the provider found pressure injuries improved for 90 patients.
Today, “We're looking forward to bringing GlideWear skin protection solutions to even more residents,” says Augustana Care Corporate Director of SNF Clinical Practice Julie Thurn.
In another example of success, 3M and the Wound, Ostomy and Continence Nurses Society announced the University of Chicago Medicine's “Countdown to Zero” skin integrity program received the 3M Award for Excellence in Skin Safety in May. The program includes helping workers learn about skin injuries in a variety of formats, such as new hire orientation, computer-based programs, formal 30-minute in-services and informal five-minute in-services conducted right at the bedside. Since the program began, the medical center has reduced all targeted preventable skin injuries, the company said.
Mobility and motivation
New solutions are sometimes found in less likely places, and sometimes it's the most commonsense approaches that turn out to be the most advanced.
This philosophy could easily apply to It's Never Too Late, a picture-based, touch-screen computer interface that allows users to “touch” their way to find engaging, educational, spiritual and personalized content that is appropriate to their own level of ability. How so? Among the many possible benefits that long-term care residents gain with the use of IN2L, one could be pressure injury prevention, according to Lori Snow, IN2L's director of marketing.
IN2L has been proven in studies to reduce the use of psychotropic drugs as well as help in the elimination of loneliness, isolation and boredom. So why not pressure ulcer prevention?
“IN2L motivates residents — those who are at risk of developing pressure ulcers — to get moving. And it works,” Snow says. “It's a whole big wellness circle.It's motivating and energizing.”
Another emerging technology comes from Essity and Plug and Play, the latter a startup accelerator in Silicon Valley. Essity joined Plug and Play's Health & Wellness innovation platform to focus on technologies around Essity's feminine care and baby care products. The relationship has now expanded to include professional hygiene and incontinence products, the company said.
“By teaming up with Plug and Play, we will strengthen our opportunities to get access to startups with the right competencies, thus enabling us to accelerate future growth,” says Georg Schmundt-Thomas, President, Essity Global Hygiene Category.