Pressure Injury

A pressure injury is a localised area of damage to the skin or underlying tissue caused by unrelieved pressure or friction that can occur in people of any age. A pressure injury can develop in the hospital environment or at home, particularly when the person is bedridden or has limited ability to move or change their position (in bed or sitting in a chair), has loss of sensation, or poor nutrition.

While pressure injuries most commonly occur over bony areas – especially the heels, elbows, hips, buttocks and tail bone–they can also occur on the ears or the nose (e.g. when the person uses nasal prongs for oxygen therapy). When a pressure injury occurs it is graded according to the severity of the damage to the skin and underlying structures e.g. stage one is reddened unbroken skin while stages two, three and four involve broken skin, with stage four being the most severe ​skin damage.

As there are a large number of patients admitted to The Wesley Hospital with complex medical problems, that increase their risk of acquiring a pressure injury, we conduct regular patient skin assessments.

Identifying pressure injuries with unbroken skin (stage one) helps prevent progression to a more serious one. Monitoring the number of pressure injuries acquired in the hospital allows us to review our practice and measure the effectiveness of our pressure injury management strategies. We aim for zero stage three and four hospital acquired pressure injuries.

To prevent pressure injuries at The Wesley Hospital we use pressure relieving devices for those most at risk of acquiring a pressure injury; conduct daily skin assessments and check on patients hourly to encourage or assist them to change position, as appropriate. 

twh-pressure-injuries
This graph shows the number of patients with hospital acquired pressure injuries stage two, three and four. A lower rate is better.

What we doing to prevent pressure injury for patients in our hospital

We have a structured, UnitingCare Health-wide pressure injury prevention program to reduce the risk of patients developing a pressure injury while they are in hospital, which includes:

  • Assessing every patient on admission to identify those at risk of developing a pressure injury and identifying pre-existing pressure injuries
  • Implementing appropriate pressure prevention strategies, reminding patients to change their position when checking on patients hourly, using a planned position change regime, or using a pressure relieving mattress on their bed
  • Regularly assessing the patient’s pressure injury risk status throughout their admission, informing the patient and their carers of the patient’s risk status and explaining the prevention strategies that are put in place

How you can help

Know your risk for pressure injury. You can be at risk of pressure injury if:

  • You are confined to bed or a chair and unable to move yourself independently, or you have limited movement
  • You have loss of sensation or poor circulation
  • You have skin that is frequently moist due to perspiration, or loss of bowel or bladder control
  • You are malnourished

While you are in hospital:

  • Ask questions about your care so that you can understand your treatment plan and what to expect
  • Keep as active as possible and change your position frequently, whether you are lying in bed or sitting in a chair. If you are unable to move yourself, the nurses will help you to change your position regularly
  • Talk to your nurse, doctor or physiotherapist about what activity will help your recovery. A referral to a physiotherapist can be organised for you while you are in hospital
  • Look after your skin. Keep your skin and bedding dry. Let staff know if your clothes or bedding are damp
  • Tell the staff if you have any tenderness or soreness over a bony area or if you notice any reddened, blistered, or broken skin
  • If your skin is dry, use a pH neutral soap
  • Eat a balanced diet. If you are concerned about your nutrition, ask the nursing staff to organise a visit by a hospital dietician