Documentation of loss of skin integrity or breakdown, rashes, or incontinence has proven to be helpful in follow up and continued monitoring of patients at risk. Pressure injury documentation must include a picture in the medical record.
One of the major challenges with the implementation of any pressure injury prevention program is staff engagement because learning a new staging and documentation program can be difficult and time consuming for the staff. This can be addressed by creating incentive programs as well as allowing the staff some flexibility in the time available to complete training modules.
Another factor that presents challenges with implementing a pressure injury prevention program includes increasing the number of wound care nurses in charge of follow up of patients with pressure injuries or at risk for pressure injuries. Increasing staff education has also been shown to be helpful.
Sometimes patients with a stage I injury, who are correctively identified as being at risk intraoperatively, are lost on follow up because those concerns not communicated to the recovery nurses and eventually floor nurses and may go unnoticed until the patient develops a stage 2 or 3 ulcers.
Standardizing perioperative report serves as a reminder to nurses to mention a skin assessment as part of a routine report to the receiving floor. After a long case, nurses may neglect to mention stage 1 or 2 ulcers on a cardiac surgery patient who coded four times during the procedure. Often, the receiving nurse may incorrectly view that information as excessive and not important at the current time.
The crux of any successful intervention is the education of the staff and frequent reassessment to monitor progress. Also, it is important to identify areas of staff miseducation that can be addressed. An example of inappropriate nursing interventions that may increase the patient’s risk includes layering of bed linen, which can contribute to the development of hospital-acquired pressure ulcers.
The basis of any intervention must include a complete skin assessment, which should include skin temperature, color, turgor, moisture status, and integrity. The pinnacle of any proper skincare program is keeping the skin clean and dry while avoiding excess dryness and scaling as the primary goal. Excess moisture increases friction and contributes to shearing, thus making the skin more susceptible to breakdown. Excess moisture may arise from other sources, including sweat and drainage from nearby wounds. Additionally, chemicals in urine and feces may irritate the skin, so a good toileting program is also critical.