Module 4: Pressure Ulcers

 A PSN report must be filed for all wounds, including pressure ulcers, which develop while the patient is at Harborview.

Beginning June 7, 2006, state law requires that hospitals report any Stage III and Stage IV pressure ulcer acquired after admission to the Department of Health within 48 hours of discovering the wound. In addition, within 45 days of discovering the pressure ulcer, HMC must investigate why the pressure ulcer occurred and develop an action plan for implementing any necessary changes.


Section 1: Risk Factors

A pressure ulcer develops from constant pressure applied to skin over a bony prominence when pressure reduction measures (such as shifting one's weight) have not been taken to relieve the constant pressure.  Blood flow into the area in not available causing a lack of oxygen and nutrients to the tissues.  Nor can the lymphatic system can not function effectively in removing waste products.  This causes localized tissue damage or necrosis. Pressure ulcers are found in an individual where mobility is limited or absent or the person's cognitive ability does not support adequate movement.

Risk Factors for developing a pressure ulcer include individuals with the following:

  • Impaired sensory perception where the person lacks the mental ability or neural connection to understand and respond to pressure related discomfort.
  • Immobility where the person lacks the ability to move or is confined to the bed or chair.
  • Frequent moisture exposure which causes maceration of the skin as do irritants in the liquid.
  • Friction/ Shear, from two surfaces moving across each other, reduces tissue tolerance to pressure by abrading and damaging the skin
  • Poor Nutrition and/ or dehydration are associated with altered tissue regeneration and the inflammatory response.
  • Age - Elderly  and infants/young children are more at risk related to thinness of their skin and less ability of their immune system to fight off an infection,

Other names for pressure ulcers include pressure sore, bed sore and decubitus ulcer. 


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Last modified: 5/30/2006 9:56 AM