What Are We Measuring?
Pressure injury—also known as pressure ulcers, bedsores or decubitus ulcers—is skin breakdown that occurs because of prolonged pressure over bony prominences or under medical devices, alone or in combination with shear on skin. This injury is most common in patients who are not able to turn or reposition in the bed or chair, are underweight, and have involuntary weight loss (i.e. 10% in six months).
Pressure injury prevention includes daily skin assessment, assessment of risk of pressure injuries, early identification of skin breakdown and care to prevent worsening of the skin injury. However, some are unavoidable, such as those that develop among critically ill patients with poor blood flow, malnutrition or infection.
Pressure injuries are nursing sensitive indicators and reflect the quality of nursing care. At Mass General, Nursing and Patient Care Services reports the percentage of patients over 17 years of age who acquire pressure injuries in the hospital. These data are compared to the rate of pressure injuries for similar sized hospitals in Massachusetts, as reported on patientcarelink.org. Nursing and Patient Care Services use these data to identify opportunities to improve the nursing care provided to our patients and families.
How We Are Performing?
Pressure Ulcer Prevalence
Lower scores are better
Mass General Source: Mass General Safety Reporting System
Peer Group Average Source: Patientcarelink.org
Date Period: January - December 2018
What Are We Doing to Improve?
Overall, the rate of pressure injuries at Mass General is low, which reflects our keen focus on prevention and early identification. When patients are admitted to the hospital, a nurse assesses the condition of the patient's skin, detects and reports skin lesions present on admission and incorporates appropriate interventions into their care plan (e.g., frequent turning, positioning, mobility and a nutrition consult). A class on pressure injury prevention and treatment is included in onboarding (orientation) for new nurses. Two additional nursing continuing education courses related to wound care, including pressure injuries, also are offered about three times per year. Unit-based clinical nurse specialists provide consultation and oversee nurses’ prevention, staging, reporting and treatment of pressure injuries. Mass General also purchased or rents a variety of special beds that reduce pressure and assist with maintaining skin health.