March 30, 2018 | Healthcare Risk, Quality, & Safety Guidance
The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury as "localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device." (NPUAP "NPUAP Announces a Change") According to NPUAP, pressure injuries can present as intact skin or as open ulcers. Pressure injuries can occur for a variety of reasons and can lead to pain, decreased quality of life, psychological stress, loss of work, and even death, with an estimated 60,000 patients dying each year as a direct result of pressure injuries (Becker's).
Although many healthcare organizations have adopted programs to identify patients at risk and take steps to avoid the formation of these painful sores, pressure injuries are still prevalent in healthcare facilities. For example:
The direct and indirect costs of pressure injuries are enormous. One estimate indicates that treatment of hospitalized patients who have pressure injuries costs healthcare organizations between $9.1 and $11.6 billion per year in the United States. In 2007, CMS estimated that each pressure injury added $43,180 in costs to a hospital stay (AHRQ "Preventing"). In addition, the development of pressure injuries can also result in costly lawsuits for healthcare organizations; for more information, see Pressure Injury Lawsuits.
In 2008, CMS changed its reimbursement rules for the development of some medical conditions that have been shown to be preventable, including stage 3 and 4 pressure injuries, and will no longer pay for the care to treat those conditions if they developed after the patient was admitted to the hospital (Medicaid.gov). While this change creates an incentive for hospitals to improve practices related to pressure injuries, it also contains provisions that challenge a facility's management of patients with pressure injuries. Additionally, Medicare can penalize hospitals 1% of their reimbursement if they have high rates of hospital-acquired conditions, including pressure injuries. (Becker's)
On April 13, 2016, the National Pressure Ulcer Advisory Panel (NPUAP), a nonprofit organization dedicated since 1988 to the prevention and management of pressure injuries, announced a change in terminology from the commonly used term "pressure ulcers." NPUAP suggests using the term "pressure injuries" instead. (Pressure injuries have also been referred to as pressure sores, bedsores, decubitus ulcers, and tissue trauma.) The change was made to more accurately describe these types of injuries as they affect both intact and ulcerated skin. According to NPUAP, the new term better reflects the fact that less serious degrees of skin damage due to pressure may not result in open sores or ulcers but that deep tissue damage can occur without overlying skin ulceration.
This guidance article uses the term "pressure injury," including when referring to studies published prior to this classification change that use the term "pressure ulcer" generically without referring to the integrity of the skin (unless quoting a source directly).
Pressure injuries can be caused by many factors, but they are traditionally attributed to...