Most clinicians who care for seriously ill patients know instinctively that deep tissue injuries and severe pressure ulcers form from the inside to the outside. They have watched it happen. In fact, I have posted many videos of this process on my blog (see links below).

That’s because the primary determinant of DTIs and severe pressure ulcers is the patient’s hemodynamic status. The reason that we continue to have a steady and predicable incidence of DTIs and severe pressure ulcers is that we have failed to recognize the vital importance of hemodynamic factors in their development. That’s why pressure ulcers have been demonstrated to occur even under the very best of care, and that’s why they occur in the dying and in ICU with patients who are in shock. And that’s why some pressure ulcers are medically unpreventable. However, it’s possible that if we did a better job of managing hemodynamics, we COULD prevent some of them! You can’t develop adequate prevention strategies if you don’t understand the mechanism! (Remember that doctors refused to wash their hands until the germ theory was understood!)

Since the hemodynamic message has been hard to deliver to the medical establishment, I decided to take it to the Risk Managers and insurance companies who often have to pay out millions of dollars in frivolous litigation for pressure injuries.

Check out my blog post for Constellation about the “X factor” in pressure ulcer development. And, you can also watch the webinar that I am giving with Monica Chadwick, RN, BSN, LNCC, CPHRM, Senior Risk Consultant with Constellation (for free!) January 25th.

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