Pressure injuries are also known as pressure ulcers, bed sores or decubitus ulcers.
A pressure injury is a localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.
Prolonged pressure cuts off the blood supply to the skin, causing damage to the skin, and sometimes other tissue and muscle. The damage may occur in a very short time but it might not be noticed until days later when the skin begins to break down.
People of all ages, including babies and children can be at risk of developing pressure injuries. They can occur in people who lie in bed or sit in chairs for long periods without moving; people who aren’t eating well, have problems with skin wetness (such as with loss of bowel or bladder control), have a medical condition that restricts their ability to move or don’t feel pain from pressure.
There are 4+2 stages of pressure injuries.
The first stage is the mildest, marked by a redness that does not become white when you press your finger on it, or pain, burning, or itching in a specific area.
The second stage is if the injury below the surface of the skin forms an open wound or blister.
In stage three, the wound reaches the fat tissue under the skin. Signs of infection may occur at this stage.
Stage four is the most severe. The wound may affect muscles and ligaments and express with symptoms such as black skin, deepening of the wound, and signs of infection.
When the wound is covered with slough or dead (black) tissue so we can't see the fulll depth of the wound, this is called an unstageable pressure injury.
If the skin is still intact, but a large blood filled blister of purple discolouring suggests the pressence of damage to the underlying tissue layers, this is labelled a suspected deep tissue injury.
Pressure injuries can cause pain, loss of function, infection, delayed healing, altered body image, anger, depression, increased mortality and morbidity, longer hospital stays and ACC treatment injury claims and care costs.
It can also create a toll on the person affected, carers and their families/whānau.
Pressure injury prevention
Evidence shows 95% of pressure injuries are preventable through early identification of people at risk and subsequent careful preventative measures.
There are key actions that are globally recognised and promoted to reduce the risk and impact of pressure injuries. For example, the SSKINS bundle provides a useful approach to ensure that no prevention element is missed. It includes considering or undertaking the following:
Skin care - keep the skin healthy moisturising dry skin and avoiding soaps
Skin Inspection – undertake regular skin checks for discolouration and pain on bony prominences (such as hips and heels) and under or around medical devices
Keep moving – change position often
Incontinence– keep skin dry and clean
Nutrition – eat healthily and drink plenty of fluids.
Surface – provide a supportive and pressure relieving surface
What is happening nationally?
- ACC, the Health Quality and Safety Commission and the Ministry of Health are working together and with the health sector to reduce pressure injuries in New Zealand. Each agency has responsibility for a different area.
- ACC is working with DHBs to ensure the principles for the prevention and management of pressure injuries are implemented. The guiding principles document can be found here: ACC7758 A guide to preventing pressure injuries.
- The Ministry is providing clinical oversight (particularly from a nursing perspective) and have been focused on pressure injury management across aged residential care. Click here to access the the ministries website on pressure injuries.
- The Health Quality and Safety Commission is leading work on developing and promoting patient stories and case studies for the purpose of raising the profile of the impact of the harm from pressure and ensuring a consistent approach to the measurement of pressure injuries. Click here to see more about the HQSC pressure injury program.
What is happening locally?
ACC and Hauora Tairāwhiti are working together to ensure the principles for the prevention and management of pressure injuries are implemented. Hauora Tairāwhiti was successful in receiving two years funding from ACC to do the work and we have appointed a Clinical Project Coordinator for Pressure Injuries to help us with this. You can contact the Clinical Project Coordinator for Pressure Injuries, Elke Saeys for support or advice on: firstname.lastname@example.org
Hauora Tairāwhiti is working collaboratively with all the services in the primary and secondary sector to improve outcomes for its population. A Pressure Injury Steering Committee of primary and secondary care providers has been established and they meet monthly. As a collective, they are looking at a consistent approach to how we identify and assess risk, and implement pressure injury strategies in our rohe. They have an action plan of things they have to achieve for ACC as well as things they want to achieve for our rohe. One of the things they want to achieve for our rohe is to share resources. You can access these resources below.
The New Zealand Wound Care Society Inc: https://www.nzwcs.org.nz/resources/stop-pi-day
New Zealand Spinal Trust: https://nzspinaltrust.org.nz/resources/pressureinjuryprevention/
The Royal Children’s Hospital Melbourne: https://www.rch.org.au/kidsinfo/fact_sheets/Pressure_injury_prevention/