Author: IPRO

Unavoidable Pressure Injury during COVID-19 Pandemic: A Position Paper from the National Pressure Injury Advisory Panel

National Pressure Injury Advisory Panel (NPIAP)

The purposes of this National Pressure Injury Advisory Panel (NPIAP) Position Paper are to:

  1. Summarize the current NPIAP position regarding unavoidable pressure injuries.
  2. Examine the effects of the COVID-19 crisis on the scope of what is considered an unavoidable pressure injury.
  3. State the position of the NPIAP regarding determinations of unavoidable pressure injuries during the COVID-19 crisis.
  4. Renew the NPIAP call to collaborate on the development of criteria for the determination of unavoidable pressure injuries in acute care.

Skin Manifestations with COVID-19

National Pressure Injury Advisory Panel (NPAIP)

Many reports are occurring concerning areas of purpuric/purple skin and purple toe lesions in patients diagnosed with COVID-19 (SARS-CoV-2). Wound care providers are being asked if these skin lesions are forms of Deep Tissue Pressure Injury and/or “skin failure”. Early reports of COVID-19 related
skin changes included rashes, acral areas of erythema with vesicles or pustules (pseudo-chilblain), other vesicular eruptions, urticarial lesions, maculopapular eruptions, and livedo or necrosis. The pattern and presentation of skin manifestations with COVID-19 is more than rashes. The purpose of this paper is to guide the wound care clinician in determining if the “purple skin” being seen is a deep tissue pressure injury or a cutaneous manifestation of COVID-19.

Sepsis and Health Equity Fact Sheet

Sepsis Alliance

Highlights many racial, ethnic, and socioeconomic disparities related to sepsis. The fact sheet includes the following sepsis disparities:

  • Black and other nonwhite people have nearly twice the incidence of sepsis as whites
  • Non-Hispanic black children admitted to an emergency room are less likely to be treated for sepsis than non-Hispanic white children
  • Native Hawaiians have almost twice the burden of sepsis mortality compared to whites
  • Black children are 30% more likely than white children to develop sepsis after surgery
  • Children with severe sepsis or septic shock who are black or Hispanic are about 25% more likely to die than non-Hispanic white children
  • Adults below the poverty line have more than three to four times the risk of dying of sepsis compared to adults whose family income is at least five times the poverty line

Reducing Adverse Drug Events Related to Opioids (RADEO) Implementation Guide

Society of Hospital Medicine (SHM)

Provides step-by-step guidance to assist hospital teams in implementing a quality improvement program to improve patient safety and reduce opioid-related adverse events for patients receiving opioids, including:

  • Instituting safer opioid prescribing practices resulting in fewer adverse events, like dangerous over sedation, respiratory depression and death
  • Focusing on hospitalized patients, with essential building blocks for developing a quality improvement initiative addressing the inpatient setting
  • Creating a quality improvement project team in your hospital, gaining institutional support and securing buy-in of frontline staff to ensure successful implementation
  • Developing strategies for evaluating current processes, facilitating policy formation, identifying best practices and tracking progress against implementation goals
  • Optimizing care transitions for patients on opioid therapy in the outpatient setting
  • Exploring a customized approach to address the specific needs of your hospital

Pain Management Toolkit: Iowa’s Guide to Opioid Stewardship

Iowa Healthcare Collaborative

Resources is divided into sections that can stand alone for quick reference. Addresses the real-world situations practitioners face in daily patient care (difficult conversations, non-opioid treatment interventions, acute pain treatment, tapering, chronic pain care, managing ED patients, pain control for cancer and palliative care, etc.)

Colorado Alternatives to Opioids (ALTO) Project

Colorado Hospital Association

In 2017, CHA and its partners developed the Colorado Opioid Safety Pilot, a study that was conducted in 10 hospital emergency departments (EDs) over a six-month span with a goal of reducing the administration of opioids in those EDs by 15 percent. The cohort of 10 participating sites achieved an average 36 percent reduction in the administration of opioids during those six months, as well as a 31.4 percent increase in the administration of alternatives to opioids (ALTOs). Based on the success of the pilot, CHA has launched the Colorado ALTO Project to implement this program in all hospital EDs.

E-QUAL Opioids Toolkits: Pain Management and Safe Opioid Use

American College of Emergency Physicians (ACEP); Emergency Quality Network (E-QUAL)

Targeted at EDs concentrating quality efforts to improving safe opioid prescribing; Safe Prescribing Poster, Opioid Checklist, Optimizing the Treatment of Acute Pain in the ED, Alternatives to Opioids, etc.

Implementation of an Opioid Stewardship Program at an Academic Medical Center

American Society of Health-System Pharmacists (ASHP)

As the opioid crisis continues to affect the lives of people around the country health-systems most impacted by the crisis have taken a proactive approach in the fight. Recognizing the need for grassroots leadership to guide responsible opioid prescribing the University of Kentucky HealthCare implemented an Opioid Stewardship Program.

Establishing an Opioid Stewardship Program in Your Health System

The Joint Commission

This 1-hour webinar featured Dr. Jeanmarie Perrone from the University of Pennsylvania Medical Center & Dr. Scott Weiner from Brigham and Women’s Hospital sharing their experiences with setting up programs to encourage safe prescribing of opioids and reducing opioid-related deaths. The speakers shared pearls & lessons learned, with the idea of providing a framework for other systems to implement similar programs as we work towards solutions to the opioid addiction and overdose epidemic.