Pressure ulcers, bedsores, decubitus ulcers, pressure injuries. Although the National Pressure Ulcer Advisory Panel changed the official name from pressure ulcers to pressure injuries back in 2016, no matter what you call them, they are bad news for patients.
According to the Agency for Healthcare Research and Quality, over 2.5 million people a year develop pressure ulcers nationwide. The total cost to treat pressure injuries each year has reached a staggering $11 billion. On the human side of the equation, they are miserable for patients, often leading to excruciating pain, multiple surgical debridements, lengthy hospitalizations, and even death.
Pressure injuries affect more than the elderly
When many people think of this type of injury, the first thing that comes to mind is an elderly patient confined to bed. The elderly are not the only patients at risk, though. Other risk factors include the inability to walk (immobility), bowel or bladder incontinence, poor nutrition, poor hydration, neuro- sensory deficiency, and impaired circulation.
As a Houston, Texas medical malpractice attorney, I have handled many pressure injury cases for both elderly and younger clients. For example, I filed a medical malpractice lawsuit against a hospital and healthcare providers on behalf of a middle-aged man who developed severe Stage IV pressure ulcers on his buttocks and heels after a knee replacement surgery. He was working and able to get around before the surgery, but required 100 days of hospital and skilled nursing facility admissions to recover from his pressure injuries.
What causes pressure injuries?
Anything that causes unrelieved pressure on the skin can cause a pressure injury. The most common places for pressure injuries include the bony prominences, like the sacrum and heels. Unrelieved pressure can cause tiny blood vessels called capillaries to collapse and eventually shut off blood flow. This deprives tissue of oxygen and nutrients, and eventually death of the tissue.
Recently, medical and nursing experts have become increasingly aware that medical devices play a role in causing pressure injuries. According to a July 2018 publication by The Joint Commission, medical device-related pressure injuries now account for over 30% of all hospital-acquired pressure injuries.
The Joint Commission has found that every patient with a medical device is at risk for pressure injuries. Given that virtually every hospital patient requires at least one medical device during the hospital admission, it is easy to see the significant risk posed by medical devices.
Medical devices that have been frequently associated with pressure injuries include castes, braces, identification (ID) bands, abdominal binders, bedpans, restraints, orthopedic devices, negative-pressure wound therapy, intravenous (IV) catheters, Foley catheters, feeding tubes, and oxygen tubes.
Safety actions to prevent medical device pressure injuries
The Joint Commission accredits hospitals and has recommended several safety actions for healthcare providers to prevent pressure injuries created by medical devices.
First, comprehensive skin assessments, which can lead to proper identification and early prevention. From the many pressure injury cases that I have handled, I know that comprehensive skin assessments upon admission to the hospital, discharge from the hospital, and at least every shift, are part of the standard of care. They are typically performed by the attending physician or wound care provider, as well as registered nursing staff.
Second, educating the patient about medical devices, including how long they will be used.
Third, positioning and repositioning the patient at regular intervals to help redistribute pressure and minimize shear force.
Fourth, ensuring that the patient receives the proper size and type of the device, and that it is properly installed and in place.
Fifth, making sure that the assessment, reassessment, interventions, and other needs are appropriately documented in the medical record.
Medical record documentation is frequently a significant focus in medical malpractice cases. Quite often, defendant physicians, hospitals, and facilities minimize the importance of medical records documentation by stating that they are too busy caring for patients to write everything down. As a former hospital administrator, I know this is a weak argument. Medical record documentation has a significant role in the continuity of care. in other words, by recording assessments and patient data, healthcare providers ensure that each new shift is well-briefed on what is going on with the patient.
Finally, sixth, The Joint Commission recommends continuous monitoring to observe the patient’s baseline and the progression or deterioration of healing over time. Continuous assessing, reassessing, communicating, and providing necessary care helps to reduce medical device-caused pressure injuries and heal them when they occur.
Having handled a number of pressure injury lawsuits, I have had the opportunity to speak with medical and nursing experts about prevention. The consensus opinion is that most pressure injuries are avoidable with proper care. Of course, proper care requires hospitals and facilities to provide adequate nurse staffing to handle patient needs. I hope that hospital and facility administrators will implement these recommendations to improve patient safety.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.