Pressure Injury Prevention Strategies
Pressure injuries (formerly called pressure ulcers or bedsores) are a significant patient safety concern and a quality indicator tracked by CMS, The Joint Commission, and other regulatory bodies. Hospital-acquired pressure injuries are largely preventable, and prevention programs are a core competency for quality professionals preparing for the CPHQ exam.
Risk Assessment Tools
The Braden Scale is the most widely used tool for assessing pressure injury risk. It evaluates six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Scores range from 6 to 23, with lower scores indicating higher risk. Assessment should occur on admission and at regular intervals, with reassessment whenever the patient's condition changes.
Prevention Bundle Elements
Evidence-based prevention strategies are often organized into bundles. Key elements include regular repositioning (typically every two hours), use of pressure redistribution surfaces, skin assessment and moisture management, nutritional optimization, and minimizing medical device-related pressure. Each element addresses a specific risk factor identified through assessment.
Staging and Documentation
Quality professionals should understand pressure injury staging. Stage 1 involves non-blanchable redness of intact skin. Stage 2 involves partial-thickness skin loss. Stage 3 involves full-thickness skin loss. Stage 4 involves full-thickness tissue loss with exposed bone, tendon, or muscle. Unstageable injuries have a wound bed obscured by slough or eschar. Deep tissue injuries present as persistent non-blanchable deep red or purple discoloration.
Present on Admission Documentation
Accurate documentation of skin condition on admission is essential. Pressure injuries present on admission are not hospital-acquired and should be clearly documented. CMS does not penalize hospitals for pre-existing pressure injuries, but inadequate admission documentation can result in injuries being attributed to the hospital stay.
Quality Measurement
Pressure injury rates are typically expressed as prevalence (point-in-time survey) or incidence (new cases over time). Many hospitals participate in the NDNQI pressure injury prevalence survey. Benchmarking against national data helps organizations evaluate their prevention programs and identify opportunities for improvement.