The Cost of Pressure Injuries
Internationally, pressure injuries cost millions of health dollars per year with significant physical and psychosocial impacts on the individuals experiencing such injuries.
The New Zealand Wound Care Society (NZWCS) was involved in the creation of the 2014 international guideline: Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. This new guideline looks at evidence-based practice for pressure injuries and makes recommendations. Since the guideline has come into effect there has been a global effort to undertake the recommendations within the guideline.
This article is the first in a five-part series looking at practical ways to assist with some of the areas of following this guideline.
Facts & Figures New Zealand has not held a national database of figures related to pressure injuries and in the past variations in DHB reporting has resulted in inconsistencies. Following Australia’s figures there are estimates that in acute and sub-acute healthcare facilities, pressure injuries run at 6-48% compared with 26% for long-term care.
In November 2015 the New Zealand Ministry of Health released a project document, jointly funded by the Accident Compensation Corporation (ACC) and the Health Quality & Safety Commission (HQSC) titled: The case for investment in: A quality improvement programme to reduce pressure injuries in New Zealand.
This project document takes the stance that most pressure injuries are preventable and their prevention would create health savings of up to $694 million per year. This report includes initiatives from other countries, such as the Netherlands and the United Kingdom, who have been able to successfully reduce pressure injuries by implementation of quality improvement projects.
Overview of Pressure Injury
Pressure ulcers, bed sores and pressure sores are all examples of pressure injuries. The term pressure injury is often used because the vast majority of pressure ulcers are preventable (evidence suggests up to 95%). ACC claims being lodged under the ‘treatment injuries’ category is on the increase, with nurses being more aware of the fact that if a claim is lodged, clients can then get the help they need, which includes special pressure relieving equipment.
There is an ongoing push for pressure injuries to be considered a serious incident and to be treated accordingly due to the associated costs to healthcare and the reduced quality of life a client experiences when such an injury has occurred.
Aetiology
A pressure ulcer 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 or friction.
Pressure areas often develop on the sacrum, greater trochanter, ischial tuberosity and the heels but can develop anywhere on the body including the coccyx, occiput, clavicle, ear and nose.
Essentially, pressure in this context, is the compression of blood vessels in the soft tissue that occludes or partially occludes blood flow to the tissue causing ischaemia. Sustained pressure causing ischaemia will cause tissue necrosis. Individuals have differing levels of tissue tolerance and the ability to withstand pressure. A pressure injury can occur very rapidly, often within two to four hours. Pressure can be three to five times higher when located on a bony prominence.
Shearing is a lateral force that also has the ability to restrict blood flow to the soft tissue. This lateral force also causes damage to the soft tissue. This often occurs when a patient’s body has moved (such as sliding down the bed) while the skin remains in the same location.
Friction is often due to poor transfer techniques. This is a mechanical force that removes the top layer of skin, causing deterioration in skin condition and increasing the risk of a pressure injury.
Risk Factors
• Aging – Due to musculoskeletal changes, skin structure changes, cognitive changes, self-care ability, continence, muscle mass, mobility
• Spinal cord injury
• A history of previous pressure ulcers
• Co-morbidities – Examples include: diabetes, anaemia
• Immobility
• Provision of care – Including skill of caregivers
• Skin trauma – Examples include: pressure, shearing, friction, burns grazes, bruises
• Lifestyle – Examples include: smoking, activity
• Cognitive function – Examples include: mental health status, psychological distress
• Equipment – Due to ill-fitting equipment, user ability to use equipment, equipment in need of repair, ineffective equipment
• Surgical / medical procedures – Examples include: admission to hospital, 'de-conditioning' following prolonged bed rest, medications
• Suitability of physical environment
• Resource access – For example: financial concerns
• Nutritional status – Including dietary intake, hydration level, extremes in weight, reduced body mass
• External medical / nursing / therapeutic devices – Examples include: catheters, IDC/ SPC straps, plasters and splints, raising the head of the bed 30 degrees or more
• Level of independence / self-care – Examples include: difficulty independently undertaking self-care, lack of knowledge of carer, time constraints
• Hygiene – Examples include: sweat, moisture, regular bathing
• Continence – incontinent of faeces and/or urine
• Pregnancy and confinement – uneven distribution of weight, vascular changes
The Elderly
With New Zealand’s aging population, it is highly likely that our incidence of pressure ulcer injury is on the rise. This is due to the fact that the elderly have a higher risk of pressure injury development due to age related changes to their skin and musculoskeletal integrity. There is also an increased prevalence of co-morbidities that can affect mobility and blood supply.
A survey undertaken in Waikato rest homes showed a high rate of health conditions in residents that affected both mobility and blood supply.
In the next instalment of this series we'll look at assessment and stages of pressure injuries. mattresses, cushions, heel protectors and range of beds. We also have available a Pressure Care Guide & Product Selection flip book for the best advice on what equipment to use in the prevention and treatment of pressure injuries. Request your copy
For products to assist in pressure injury preventions and treatment please call Sharon Woodward on 0800 656 527
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