Pressure Injuries in 2018: our preventable global crisis

Clinical and Education Team on February 22, 2018 at 04:44 am

Before you read this weeks blog, check out the latest news in dementia, brain injuries and wound care!

Dementia: 2nd leading cause of death in Australia


According to researchers, circadian disruptions can occur years before symptoms of Alzheimer’s develop. The findings could help to identify those at risk of developing the neurodegenerative disease as they age.

Brain Injury: Falls are the leading cause of Traumatic Brain Injury in Australia

[SOURCE: Nick Rushworth, Brain Injury Australia]

Brain Injury Australia Completes Study On Post-Concussion Syndrome/ “Mild” Traumatic Brain Injury 

Wound Care: Annual treatment cost of Pressure Injuries in Australia is A$983 million


Resources for optimising wound outcomes in low-resource settings


And now back to the blog…

Immobility is endangering our patients!

Right now in 2018, we are at a place where we know more about the prevention and management of pressure injuries (PIs) than ever before in medical history. In recent years there has been an exponential growth in treatment with a disproportionate lack of prevention of pressure injuries, making PIs our preventable global crisis. PIs are far more expensive to treat than to prevent. PI management costs in Australia are estimated at A$1.6 billion annually1.

We are not lacking in our ability to treat, our current failing is in our inability to prevent.

By default, we are more interested in paying for treatment than investing in prevention.

Be under no illusions, patients die from PIs.

In my home state of Queensland, Australia there have been two Coroners investigations into aged care residence related deaths in the past five years.

“Education is foundational for pressure injury (P.I.) prevention”2.

Except in critical situations such as long surgeries (some neurosurgery and orthopaedic procedures can last more than 8 hours), pressure injuries ARE PREVENTABLE!

If we are serious about developing and maintaining a culture of effective pressure injury prevention we need to be considering the following:

1. Aged care wards people (also known as operational support staff). In Australia, aged care staff are statistically middle aged, female and of smaller stature with a propensity towards working quickly and suffering from the cumulative effects of lower back pain. The development of a job pathway for wards who undertake manual handling in hospitals would be one way to increase the frequency of the clearly inadequate repositioning whist decreasing the present culture of developing cumulative lower back pain.

2. Recognition that a lot more Stage 1 PIs are developing and being left unnoticed (and therefore untreated) than we realise. With personal carers/care workers (PC/PCW) and Assistants in Nursing (AINs) being the people tasked with repositioning patients as opposed to clinical staff, they need to be the ones most conversant with recognition of Stage 1 PIs. The reality though is that if asked to describe Stage 1 PIs some care staff will simply say ‘I’m not a nurse’ etc. It is the clinical staff not the care staff who attend the continuing professional development courses in advances in pressure injury prevention and management. Care staff need to be empowered to be ‘Masters of Pressure Relief’ who can describe and identify Stage 1 PIs without having to think about it or refer to posters etc. It needs to be learned and relearned and relearned with the same muscle memory development given to cardiopulmonary resuscitation training. With facility fines for pressure injury development of pressure injuries in the region of a A$30k per incident, where is the incentive to do the very best to prevent them? This leads to underreporting and finger-pointing for example ‘Mrs jones didn’t have a pressure injury when she left our aged care facility, but she came back from hospital with one’.

3. Prevent the deterioration of Stage 1 and 2 to Stage 3 and 4 pressure injuries.

The foundation of pressure injury prevention and management is education. Education of staff, patients and families.

The NPUAP redefined the definition of a pressure injuries during the NPUAP 2016 Staging Consensus Conference that was held in April 2016 in Chicago, IL. And there are now 7 categories of PIs:
-Stage 1
-Stage 2
-Stage 3
-Stage 4
-Unstageable Pressure Injury: Depth unknown
-Suspected Deep Tissue Injury: Depth unknown
-Mucosal Membrane Pressure Injury





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February 22, 2018

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