Dear Clinical Professional,

Thank you for your interest in my pressure injury prevention products. I appreciate our shared desire to stop pressure injuries.

Our healthcare system is entering the perfect storm. There is an exponential increase in our aging population, and diabetes and obesity rates have reached epidemic proportions. Throw in the nursing shortage and unaffordable healthcare costs, and you can watch the hurricane bring a flood of high risk patients into the hospital.

I would never try to say that pressure injury is an easy problem to solve. Certainly its complicated and we can’t prevent them all, but I believe we can prevent most. Here is what I recommend.

I read 400 something page Agency for Healthcare Research and Quality guidelines (https://www.ahrq.gov/) and the 305 page National Pressure Ulcer Advisory Panel “Prevention and Treatment of Pressure Ulcers Clinical Guideline” (http://www.npuap.org/resources/),

And I have also spent 14 years at the bedside. For the sake of time and to save you energy, I can boil it down to the 3 principals any facility must address before any pressure injury prevention program can be successful.

You can spend millions on the high tech, but the best bang for your buck is the dollars you invest in multidisciplinary interventions. Here is the entire NPUAP and AHRQ recommendations in a nutshell.

Step 1: Get the pressure off

I shouldn’t have to say this. I mean they don’t call em pressure injuries for nothing.  It never ceases to amaze me that we don’t prioritize pressure reduction, but we don’t. I got into this business because I recognized the need to elevat the priority and advance the science of turning and repositioning.

A lot of people ask me if my cushions will prevent pressure injuries. I wish. If my wedge cured pressure injuries I would probably be writing about my Noble Prize instead of this. But no, you still have to do everything else. What I can say is if you don’t remove the pressure, everything else wont work.

Turning and repositioning needs to take top priority. Both in terms of educating and empowering staff to do it correctly (so that pressure is truly reduced!) We must have access to equipment that correctly supports our patients in a pressure reduced position. Before we drop thousands of dollars on a really good mattress, lets invest tens of dollars on a good support device. You can go with whatever device you think is best, but using a common pillow because you are not satisfied with the evidence of a positioning device made for this purpose is like making a person a witch because she didn’t float. The only good evidence we have is that the common pillow does not work.  Not for any longer than 15 minutes anyway. Facilities that emphasize quality turning over quantity turning will see an immediate drop in incidence and prevalence.

Second Priority: Support the basics

Somewhere along the line many facilities have left the most important care for pressure injury prevention to the least trained and most undervalued staff in the facility. I’m not talking about just turning and repositioning, but also toileting/peri-care, PO nutrition and hydration and mobility/ambulation. No matter what you do with the technology, you still at least one person (and very often 2 people) to do basic nursing care, often. Facilities that fail to adequately support this time consuming, high labor activity will see an increase in pressure injuries. Period. Above that, the only reason facilities lose most pressure injury lawsuits is because the plaintiff is able to prove that basic care was neglected.

Third Priority: Respect the science of skin and wound care

Skin is our largest organ and wound care is a highly complex and advanced science. There are many pathophysiological conditions that contribute to pressure injury development alone, not to mention the other wound pathologies that add to the 20-30% of the inpatient population who have wounds.  Most facilities are willing to employ an army of cardiac specialists, GI, Neuro, ortho, nephrology, urology etc, but only one wound care nurse specialist, if that. If you have a 300 bed facility, that’s a case load of about 60-90 patients a day. I know that billing for wound care nurses time is a problem (yes I object to that too!) but if your facility is not willing to invest in wound care clinicians, it should come as no surprise that they spend more in pressure injuries and extended lengths of stay.

Effective prevention and treatment of pressure injuries is a complex science that requires the input and participation of all clinical disciplines. If a facility hopes to keep pressure injuries under control, the organization and structure of the prevention program must designed to be sustainable and accountability must be distributed across the entire continuum.

Gwen Jewell, Clinical Nurse II, BSN, CWS
Founder, Jewell Nursing Solutions