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The Joint Commission releases Quick Safety advisory on early identification and evaluation of severe pressure injuries

Tuesday, October 10, 2023

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Katie Bronk
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(OAKBROOK TERRACE, Illinois, October 10, 2023) – Pressure injuries can be deceptive, and many harbor a much deeper pressure injury than is apparent to the naked eye. When evaluating a pressure injury, bedside nurses and clinicians need to look for certain warning signs and symptoms that should trigger a surgical consultation and evaluation for the need for debridement.

Each year, more than 2.5 million Americans develop a pressure injury, according to the Agency for Healthcare Research and Quality (AHRQ). Even worse, severe pressure injuries can put patients at risk for potentially worse outcomes, including amputation, unnecessary pain and suffering, and systemic infection. To aid bedside nurses and clinicians in preventing pressure injuries from becoming more severe, The Joint Commission has issued a new Quick Safety advisory, “Early identification and evaluation of severe pressure injuries.”

The Quick Safety advisory details common risk factors for developing pressure injuries, including: 

  • Immobility due to any cause (e.g., neurological impairment, prolonged anesthesia)
  • Lack of sensory or pain perception (e.g., neuropathy, diabetes)
  • Poor nutrition or dehydration
  • Obesity or low body mass index (BMI)
  • Prior history of pressure injuries
  • Dementia

Bedside nurses and clinicians need to look for warning signs that can indicate the presence of a severe, concerning pressure injury. The Quick Safety names signs of a severe pressure injury that, if present, demonstrate need for a surgical consult. Some of these signs include:

  • When pressing on the injury, it expresses additional exudate and/or the top layer of the skin/site dislodges.
  • A thin blister forms over the surface of the dark wound bed; the wound may become covered by thin eschar.
  • The patient has any systemic symptoms of infection or sepsis, no matter how mild they may initially appear.

In addition, the Quick Safety identifies safety actions that organizations can take to help clinicians accurately identify the depth of a pressure injury as early as possible in order to treat the patient and ease their suffering: 

  • Develop and implement an organizational policy outlining a structured skin assessment approach relevant to the clinical setting to promote the performance of regular assessment.
  • Use a pressure injury classification system in pressure injury-related education to staff.
  • Post signage and/or illustrations that indicate the warning signs and symptoms that clinicians should look for to enable rapid identification of more concerning pressure injuries.
  • Health professionals undertaking comprehensive vascular assessment should be trained in using appropriate assessment techniques and equipment.

The signs and safety actions named in the Quick Safety can aid clinicians in their decision to refer patients to a vascular specialist, reconstructive surgery or wound team.

“Pressure injuries, in addition to causing unnecessary pain and suffering for the patient, can result in severe morbidity for patients who are bedridden, unconscious, unable to sense pain or immobile,” says Shirley G. Legaspi, MSN, RN, CPPS, patient safety specialist, Office of Quality and Patient Safety, The Joint Commission. “Bedside nurses and clinicians can help restore dignity to patients who are often unable to care for themselves, as well as prevent further harm, by monitoring these patients for pressure injuries and escalating concerning pressure injuries for a surgical consult.”

The full Quick Safety advisory is available on The Joint Commission website. It may be reproduced if credited to The Joint Commission.


About The Joint Commission

Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission accredits and certifies more than 22,000 health care organizations and programs in the United States. An independent, nonprofit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at