Prevention of Pressure Injuries in Home Care Begins with Strong Protocols, Risk Management

Pressure ulcers, also known as bedsores and most recently replaced by the term pressure injuries, are a common and painful health condition, particularly among the elderly. A pressure injury is defined as “localized injury to the skin and/or underlying tissue usually over a bony prominence or related to a medical or other device.” The injury can present as intact skin or an open ulcer and may be painful. There is a staging system assigned to pressure injuries to indicate the extent of tissue damage. While not as prevalent a problem in home health care as in nursing homes, pressure injuries are still a major health care problem overall and one of the biggest challenges providers face on a daily basis. However, pressure injuries can be prevented when strong protocols and a coordinated risk management strategy among members of the home health care team (family, caregivers, nurses, and general practitioners) are in place.

Pressure injuries affect an estimated 3 million adults in the U.S. with persons over the age of 65 having a 60-95% chance of pressure ulcer development. In the U.S., pressure injury care is estimated to approach $11 billion annually, with a cost of between $500 and $70,000 per individual pressure ulcer, according to the National Pressure Ulcer Advisory Panel (NPUAP), a non-profit organization dedicated to the prevention and management of pressure ulcers

The key to managing pressure injuries in a home health care environment is to be extremely proactive and prevent them from occurring with standardized protocols. First, it is important for members of the home care team to become familiar with patient populations at increased risk for pressure injury development. These include but are not limited to patients with peripheral vascular disease, myocardial infarction, stroke, multiple trauma, musculoskeletal disorders/ fractures/contractures, gastrointestinal bleeding, neurological disorders (e.g., multiple sclerosis), unstable and/or chronic medical conditions (e.g., diabetes, renal disease, cancer, chronic obstructive pulmonary disease, congestive heart failure), history of previous pressure ulcer, and dementia.

Pressure injury prevention also involves implementing an interdisciplinary approach to care among the team responsible for each patient for early detection and educating the family and all homecare workers on the risks associated with pressure injuries. A home care agency should be promoting an organizational culture and operational practices that promote teamwork and communication in developing and carrying out a high-quality prevention and identification of risk program.  Following are general strategies to observe:

  • A risk assessment of the client/patient should be performed on a regular basis using a standardized tool. The Braden or Braden Q Scale is recommended.
  • A skin inspection should be done on every new patient by the home health care agency to assess if there are any pressure injuries and for the family and nursing staff to work in partnership to check for signs of developing pressure injuries.
  • Be sure every patient and caregiver is educated on AHCPR (Agency for Health Care Policy and Research) guidelines and prevention of pressure injuries. Possible content of education includes causes of pressure injuries, ways to prevent them, dietary needs, and positioning.
  • Include in the plan detailed interventions that minimize or eliminate friction and shear, minimize pressure with off-loading, manage moisture, and maintain adequate nutrition and hydration.
  • Pressure injury treatment should be evidence-based and include a patient assessment and wound evaluation, including the following elements: history and physical, wound description/staging, etiology of pressure, psychosocial needs, nutritional status, and bacterial colonization/infection.
  • Document all risk assessments, skin inspection findings, pressure injury prevention interventions and treatments.
  • Communication of pressure injury development, risk assessment, skin inspection results, and treatments should be consistent. Any change in skin condition should be communicated to direct and indirect care providers as soon as observed.  Readmittance to a facility is often necessary to remove the patient and the risk from the home care environment.

Pressure injury prevention is complex, as conflicting procedures and protocols may exist. Multiple health care team and family members may be involved in caring for the patient, and limited knowledge may result in misunderstanding of procedures. This is why it’s so important for home health care providers to have consistent risk assessment and prevention strategies in place.

About Manchester Specialty

Manchester Specialty provides total insurance solutions to home health care providers. The responsibilities of a home care team are diverse, and adequate professional liability insurance coverage is necessary for a successful organization. For more information about our business, insurance lines, you or your local agent/broker may contact us at 855.972.9399.


Sources: Agency for Health Care Policy and Research, Quick Safety