Skin Assessments Key to Preventing Pressure Injuries

Nov 03, 2020

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Study published in American Journal of Critical Care finds irritated skin is strongest predictor of pressure injury development in surgical critical care patients

ALISO VIEJO, Calif. – Nov. 3, 2020 – Nursing assessments of patients’ skin conditions may seem routine, but an analysis of more than 5,000 patient records underscores the importance of treating and monitoring irritated skin early and eliminating the cause as an important step to prevent pressure injuries.

"Risk Factors for Hospital-Acquired Pressure Injury (HAPI) In Surgical Critical Care Patients" examined data in electronic health records (EHRs) related to nursing skin assessments, along with other factors. The study is published in the November issue of American Journal of Critical Care (AJCC).

The results reinforce that changes in the skin, such as irritation and redness, should be considered influential risk factors for HAPI and promptly treated by eliminating the cause.

Co-author Jenny Alderden, PhD, APRN, CCRN, CCNS, is an assistant professor at the University of Utah College of Nursing, Salt Lake City. She is a critical care nurse specialist with expertise in pressure injury risk assessment and prevention, and serves on the University of Utah pressure injury prevention committee. In addition to the research team at the University of Utah, leading pressure injury researchers from Duke University School of Nursing, Durham, North Carolina, and the Department of Veteran Affairs James. A. Haley Veterans’ Hospital and Clinics, Tampa, Florida, provided expertise for the project.

“This study demonstrates the power of using informatics to analyze the vast amounts of data in electronic health records,” Alderden said. “Critical care nurses routinely conduct head-to-toe skin assessments every 12 hours and document changes in condition in the EHR. Modern informatics approaches enable us to more easily examine large-scale, real-world data available in the health record to gain insights and improve outcomes.”

The retrospective cohort study included data from surgical critical care patients admitted to the surgical intensive care unit (ICU) or cardiovascular surgical ICU at the University of Utah Hospital, Salt Lake City, from 2014 through 2018. The research team analyzed five years of data from 5,101 patients using a modern statistical test called Least Absolute Shrinkage and Selection Operator (LASSO).

Of the 399 patients in the sample who had a HAPI develop, 110 patients had a stage 1 pressure injury develop, with 40% (44) worsening to a more severe stage during their ICU stay.

The most common pressure injury location was the coccyx, followed by the buttocks, sacrum and an extremity excluding the heel.

The research builds on the team’s ongoing work to develop and test its machine learning model to predict pressure injury development in critical care patients. The long-term goal is to develop a predictive model that will be deployed in the EHR to provide real-time decision support, enabling nurses to identify patients at highest risk for pressure injury and to apply targeted interventions.

This research was funded by an American Association of Critical-Care Nurses–Sigma Critical Care Grant. This study was also supported by the University of Utah Population Health Research Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health.

To access the article and full-text PDF, visit the AJCC website at

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 120,000 acute and critical care nurses and can be accessed at

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 120,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656-3399; 949-362-2000;;;