We designate many days to celebrate good causes and memorable occasions – probably enough to fill the full year’s calendar – but this is one of the lesser-known ones, in my experience. But not one representing an unimportant or trivial concern.
The aim of the day is to raise awareness of pressure injuries and how to prevent them. Key messages are:
• with the right knowledge and care, pressure injuries can be avoided.
• all health professionals, carers, family/whanau members and patients have important roles to play in prevention.
• skin care matters.
STOP Pressure Injury Awareness Activities are planned around the country.
The Accident Compensation Corporation (ACC), the Health Quality & Safety Commission (HQSC) and the Ministry of Health are leading a multi-agency approach. These organisations have been working for several years towards a national strategy for monitoring and reducing harm from preventable pressure injuries, starting with the in-hospital and residential care settings. Pressure injuries are often regarded as a marker of quality care because the risk rises when care rationing, understaffing or lack of awareness, results in patients not being regularly moved in bed or having their skin assessed. However, where possible, patients are also encouraged to take steps to prevent pressure injuries and speak to someone involved in their care if they have concerns.
While the exact prevalence of pressure injuries in New Zealand is unknown, it is estimated that they affect approximately 55,000 people every year, resulting in direct costs of some $694 million per annum, according to a KPMG report (2015). Most cases of pressure injuries are preventable – and prevention is a high priority for all the agencies involved. As well as having a significant financial impact on the health system, pressure injuries can have a substantial impact on peoples’ lives and wellbeing.
ACC’s Chief Clinical Officer, Dr John Robson, says thousands of New Zealanders get a pressure injury every year.
“We know these injuries can have a huge impact on quality of life for people, often resulting in a long period of bedrest and social isolation, and in extreme cases can cause death,” he says.
“They also put pressure on our health system by occupying hospital beds and utilising valuable resources. These injuries can largely be prevented – that’s why we are encouraging health professionals to have conversations about prevention with patients who might be at risk.”
Pressure injuries (also known as ‘pressure ulcers’ or ‘bedsores’) can range from a blister to a deep open wound, which can be difficult to treat and might take months to heal. In extreme cases surgery is required to treat and repair the skin and tissue damage.
Pressure injuries are caused when people stay in one position for too long and develop where the body takes weight and where the bones are close to the surface. Anyone can get pressure injuries, but they are most common for people who are sitting or lying for long periods, using a wheelchair, or medical equipment that has contact with the skin. Therefore, older people with chronic health problems are especially susceptible.
These injuries can be prevented by regular shifting in position when sitting or lying and by careful bedding arrangements, such as positioning of pillows and cushions. Nurses and other carers need to be alert to the dangers as well as the people directly involved.
A tangible evidence of all this activity can be seen in notices prominent in hospitals and rest homes. This is the SSKIN initiative – recommendations to reduce the risk and impact of pressure injuries.
• Surface –ensure a supportive and pressure-relieving surface (mattress) is available
• Skin inspection – undertake regular checks for discolouration and pain on bony areas (such as hips and heels) and under or around medical devices
• Keep moving – change position often
• Incontinence – keep skin dry and clean
• Nutrition – eat healthily and drink plenty of fluids.
In October 2016, the HQSC published its report ‘Developing a National Approach to the Measurement and Reporting of Pressure Injuries” informed by a multidisciplinary advisory group. The New Zealand Wound Care Society Inc: (www.nzwcs.org.nz) and the Nursing Council of New Zealand: (www.nursingcouncil.org.nz ) are also involved.
“Guiding principles for pressure injury prevention and management in New Zealand Review” Accident Compensation Corporation May 2017
Ministry of Health – HealthCERT Bulletin ‘Pressure Injury Prevention and Management’ (MoH) (www.acc.co.nz/assets/provider/acc7758-pressure-injury-prevention.pdf
Pressure injury prevention resources, which include a patient-focused flyer in 15 languages, posters, and a classification chart for clinicians are available on the NZ Wound Care Society website and printed copies can be ordered at no cost from ACC’s online ordering system