By Edwina Murphy, OTR, ATP, CAPS, Senior Director of Rehab Technology, ATF Medical
Imagine being seriously injured on the job and then developing a painful pressure injury that keeps you in bed–an injury you would not have had if not for the work-related injury. That feels like insult on top of injury, doesn’t it?
Pressure injuries—also known as wounds, pressure ulcers, and bed sores—can be painful for patients who have sensation, and the treatment can include confinement to bed. Wounds are difficult to heal, especially in the uncontrolled environment of an injured worker’s home. Keeping bacteria away from the injury, making sure the home is clean and the injured worker has proper hygiene, follows a pressure relieving program, and eats nutritious food pose considerable challenges.
Plus, people can die from pressure injuries. They can develop infections, including sepsis, which killed “Superman” star Christopher Reeve. Around 60,000 people in the US die every year from pressure injury complications.
In addition, pressure injuries are expensive, hospital treatment ranges between $20,900 and $151,700 per pressure injury.
What is worse: most pressure injuries are preventable.
Unrelieved pressure causes these injuries. This can happen when soft tissue meets a surface. Pressure can build up when a person sits or lies on a surface too long. Continuous pressure slows or stops blood flow and that can lead to death of tissue.
The pressure does not have to last that long; damage can occur within two hours. And the external surface doesn’t have to be that hard. Even keeping IV tubes in place too long can cause these injuries.
Shearing or friction also produce pressure injuries. Fragile skin dragged across a surface as soft and light as a sheet can blister or tear. Something as innocuous as sliding up or down in bed or transferring from a bed to a chair can do it.
What can payers do to prevent them?
The first step is to analyze the files of all injured workers who receive home health care and determine who is at risk for developing a pressure injury. For example, injured workers who have spinal cord injuries or peripheral neuropathy run a very high risk of developing pressure injuries. Risk markers include comorbidities, such as diabetes, steroid medications, and exposure to moisture (incontinence). Low blood flow to tissues and organs, aging, poor nutrition, weakness, and limited mobility are others.
Second, evaluate these injured workers using a validated screening questionnaire, such as the Norton Scale or Braden Scale, along with pressure mapping. Pressure mapping pinpoints hot spots, areas where pressure injuries are developing or will likely develop. Injured workers can see a spot turn from hot red to a cool blue as they reposition. These striking images encourage patients to become much more compliant with their pressure relief programs.
It is best to have an Assistive Technology Professional, Occupational or Physical Therapist, or a Certified Complex Rehabilitation Technology Specialist conduct assessment. They have experience with durable medical equipment and know how to adjust it, make recommends for the most suitable cushion or mattress and educate the injured worker regarding proper positioning and pressure relieving techniques.
Third, implement recommended DME changes and create a pressure injury prevention program for the injured worker. There is a wealth of excellent information on preventing and caring for pressure injuries available from respected nursing associations, DME manufacturers, organizations such as the National Pressure Injury Advisory Panel (NPIAP) and the Rehabilitation Engineering and Assistive Technology Society, better known as RESNA.
Unfortunately, this information is not all in one place or tailored for your injured worker. A large body of information from disparate sources must be compiled, condensed, and customized for a specific person, injury, and environment.
The program needs to be concise and easy to implement. Also, it should be shared with all the claim’s stakeholders. Treating physicians, therapists, claims representatives, wound care centers, managed care companies, the injured worker and family, and home health agency staff must be on the same page.
Monitoring for pressure injury development is a critical part of the program because wounds are so prevalent in patients receiving home health care. Research shows that people with community-acquired pressure injuries are much more likely to need hospital treatment for them than patients whose injuries developed in the hospital. Over the three-year study period, 821 patients with community-acquired injuries had to receive hospital treatment, compared to only 45 whose injuries originated in the hospital.
The injured worker needs to understand just how serious pressure injuries are and how to prevent them. Home health nursing aides usually see them most often, making them well positioned to reinforce patient education and observe changes.
Claims representatives can monitor the prevention program by requesting reports on its points. Is there regular pressure relief every 20 minutes? Any changes in the skin? How clean is their environment? Are they hydrating and eating enough protein? Are they being turned at night if needed?
Having everyone on the same page leads to accountability.
Pressure injuries cause injured workers unnecessary pain and suffering, while limiting mobility and independence. They delay recovery and most certainly drive costs. Prevention techniques are usually conservative, things like teaching the person to reposition or changing a mattress or other DME.
When it comes to pressure injuries, an ounce of prevention is worth a pound of the cure.
About Edwina Murphy
Edwina Murphy has over 20 years of experience in Rehabilitation Technology and 15 years as an Occupational therapist. As Senior Director of Rehabilitative Technology, she oversees the Pressure injury and Prevention Program, provides education for new employees, conducts home safety evaluations, and markets services to potential customers.
Murphy worked as an Assistive Technology Practitioner for seating and mobility companies prior to joining ATF Medical in 2019. A native of Ireland, she has served patients and injured workers in the United States, England and Ireland. Murphy has worked in multiple settings, in-patient, out-patient and the community. A graduate of St. Joseph’s College of Occupational Therapy in Dublin, Ireland Murphy is a licensed Occupational Therapist and Certified Assistive Technology Professional.
About ATF Medical
ATF Medical provides all the medical equipment and adaptive housing projects required for a complex workers’ compensation claim.
Specialists assess injured workers and their homes and recommend and implement solutions to foster mobility, independence, and safety. Clinically driven, outcomes-oriented solutions include DME, such as complex rehab chairs, home access equipment, and hospital beds. ATF Medical stays involved for the life of the claim, fitting equipment to injured workers and educating them on its use and care and maintaining and servicing DME for the life of the claim. In addition, the company provides a pressure injury prevention program and efficient, cost-effective home modifications.
Known for its stellar service, ATF Medical takes work off the desks of claims representatives by handling the myriad details of ordering and scheduling and ensuring that work is done on time and within budget. Clients include workers’ compensation ancillary service providers, carriers, employers, and other payers.
Formerly known as After the Fall, ATF Medical was founded in 2001. For more information, visit www.atfmedical.com or call 877-880-4283.