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Pressure Injuries

Pressure injuries, also called bedsores or decubitus ulcers, are skin injuries caused by pressure from body weight over bones. This results in friction against surfaces like beds, chair seats or medical devices. Injuries occur when blood flow is temporarily cut off to body areas under pressure.  

A drawing of inpatient care for Tufts Medical Center in downtown Boston, MA.

Who is at risk for a pressure injury?

  • People who have been bedridden for a prolonged period of time or are unable to move for a short period of time.
  • People who are very thin, suffer from excessive body moisture, experience problems with bowel and bladder control or have blood vessel disease or neurological diseases.
  • People confined to chairs and those with limited mobility.
  • People with multiple health issues, poor nutrition and the elderly. 

Having pressure injuries can cause other health issues so it’s important that staff at Tufts Medical Center help patients avoid these injuries.

What are we doing to prevent pressure injuries from occurring?

At Tufts Medical Center, we’re committed to preventing and reducing health issues related to pressure injuries in the hospital and at home. Ways in which we monitor and treat our patients at risk for developing pressure injuries include:

  • Working as a team to assess our patients’ overall health during appointments and hospitalizations, and communicating each patient’s unique needs to those involved in their care.
  • Evaluating and assessing patients for risk of developing pressure injuries at the time of admission, before and after procedures, upon changes of clinical condition and every day of their hospitalization.
  • Employing skin and wound care experts to assure that every patient’s skin and wound care needs are being met by their care team using the very best, most current, scientifically-based practices and treatments.
  • Educating our direct caregivers to prevent and treat pressure-related injuries according to evidence-based guidelines.
  • Providing pressure relief for all patients using state-of-the-art support surfaces (beds, mattresses, chair cushions, etc.) to reduce the risk of pressure-related injuries.

What measures are we taking to monitor how we are doing?

Monitoring our processes occurs in several ways. All members of the care team are involved in keeping patients pressure injury free. All patients are monitored daily for pressure injury risk or more often depending on their condition. The risk and plan for prevention and treatment are documented in patients’ records and shared between caregivers from shift to shift to assure that everyone works together toward the same goal. Additionally, monitoring is done:

  • Daily – consultation with skin and wound experts for patients at risk for pressure injuries.
  • Weekly – multidisciplinary “pressure injury prevention” rounds in the intensive care units evaluating the progress of patients considered being at high risk for pressure injury development.
  • Monthly – evaluation of hospital or care unit-acquired rates of pressure injury by Tufts MC leadership teams.
  • Quarterly – head to toe assessment of all Tufts MC patients performed by direct caregivers with oversight by the skin and wound experts to assure that every patient is monitored.

How can patients and families contribute?

There are six important ways patients and families can contribute and work as partners in keeping patients free from pressure injury development:

  1. Remembering to keep moving while in the hospital if/when possible. More movement prevents pressure from building on those body parts prone to pressure, i.e., hips, buttocks, heels, elbows, etc.
  2. If you need help moving, ask members of your care team to help you move or provide you with the tools you need to reposition.
  3. Eat a well-balanced diet. Your body needs the right nutrients to improve overall health and reduce pressure injury risk. Ask your dietitian if you need assistance.
  4. Monitor your own skin daily. Patients with a history of previous pressure injuries, any loss of circulation or sensation, incontinence of bowel and/or bladder, excessive moisture or existing skin cracks or sores are at greater risk. Discuss any former or recent skin issues with your care team.
  5. Stop smoking. Smoking reduces the amount of blood oxygen available to your skin especially when it’s under pressure. Discuss quitting strategies with your care team.
  6. Every day ask your nurse, “How is my skin looking?”

How are these strategies being evaluated?

Tufts Medical Center voluntarily reports the number of hospital-acquired pressure injuries to an organization that makes the overall number in each care unit available to the public every three months. The website, PatientCareLink, is managed by a healthcare quality and transparency collaborative comprised of Massachusetts hospitals, their nursing leaders and home healthcare agencies throughout the commonwealth. All contributing hospitals provide their pressure injury numbers and other information about patient care conditions specific to hospital stays to the quality agency. It’s then compared against other Massachusetts hospitals, the group average is determined, and the information is displayed so that the public can see how each facility is doing over time based on these “indicators.”

How are we doing?

Tufts Medical Center has significantly lower rates of pressure injuries for Adult Critical Care, Adult Surgical and Adult Medical-Surgical Combined when compared to our Peer Group Average. 

Pressure ulcer prevalence at Tufts Medical Center in downtown Boston, MA.

Source: PatientCareLink