Review of Literature- Application of an Interdisciplinary Approach and SSKIN Bundle as Interventions to Address Pressure Injuries

Pressure injuries (PIs), especially among patients in long-term bed care and prolonged bed stays with limited mobility, remain an issue of concern in nursing homes. The recurrence of PIs and the association of PIs to deteriorating health conditions significantly contribute to longer lengths of stay and higher costs of care in patients in long-term care settings. A study by  Padula and Delarmente (2019) estimated that the national cost of hospital-acquired pressure injuries (HAPIs) was at a high of $26.8 billion in the United States alone. These costs and risks of recurrence of PIs raise arguments on the feasibility of treating and preventing PIs. Singh et al. (2022), in a review of the literature on the costs of healing and preventing PIs drawn from multiple countries and settings, noted that caring for 206 patients with HAPIs had an accumulated cost of $2,204,200 throughout the treatment period. In the United States, the cost of treating a single patient with stage PI per patient in a year was estimated to be $31,485 between 2019 and 2020, while the cost of preventing a PI per patient per day was $21 while in Netherlands compared costs for preventing PIs were €0.50 per patient per day, while the cost of treating a stage 3 PI was €77.36 per patient per day within a similar period and care settings (Singh et al., 2022). This evidence suggests that focusing on PI prevention rather than treating PIs is a more cost-effective strategy for addressing PIs by reducing the overall burden of PIs on patients.

Various strategies for addressing PIs exist. However, the effectiveness and costs of implementation vary. This paper explores the effectiveness of the application of an interdisciplinary approach and SSKIN bundle as interventions to address pressure injuries. It also identifies factors that favor the application of each intervention in addressing PIs. The proposed PICO(T) question to guide the literature search is, “In patients at a high risk of pressure injuries (P), does an interdisciplinary approach and SSKIN bundle (I), compared to usual care and treatment (C), effectively reduce the incidence of pressure injuries (O) over a period of 6 months periods (T)?”

Synthesis of Literature

An electronic literature search utilizing “interdisciplinary approach in PI prevention,” “SSKIN bundle in PI prevention,” and “PI prevention and treatment costs” as main search phrases returned multiple related search results. A total of ten scholarly peer-reviewed articles that directly related to the interdisciplinary approach and SSKIN bundle in PI prevention and the feasible PI prevention interventions were selected and reviewed. Themes related to the interdisciplinary approach included interdisciplinary communication, provider demographics, and integrated wound care teams (IWCT). Themes related to the SSKIN bundle include skin assessment, sub-epidermal moisture (SEM) measurement, nutrition, patient repositioning, and the support surface.

Interdisciplinary Approach

Interdisciplinary collaboration is essential to pressure injury (PI) care and prevention. Care for high-risk patient populations is usually segmented based on population and varied population needs. In all cases, multiple healthcare teams from various disciplines and professions must work together in most long-term care settings for patients. As the risk of developing PIs is high in such settings, various aspects of interdisciplinary teams, such as communication, evidence-based decision-making, and integrating various care perspectives, are essential for effective care for high-risk patients.

Interdisciplinary Communication

Effective communication is a vital element in all care settings. The possession of good communication skills is the driving force of all interdisciplinary approaches in patient care and for positive patient- and provider-related experiences and outcomes. Evidence has linked interdisciplinary roles to the development of communication skills as well as interdisciplinary communication, leading to significant and desirable outcomes in the care management and prevention of PIs in long-term care settings. A quality improvement project conducted by Al-Mansour et al. (2020) involving creating an interdisciplinary healthcare team for managing patients with stage 3, stage 4, and unstageable pressure injuries (PIs) led to improving communication between the interdisciplinary team members. Additionally, the improved communication improved the care of patients with PIs due to a better understanding of PI care management and adherence to care plans (Al-Mansour et al., 2020). The overall outcome of the improved interdisciplinary communication was a notable reduction in the rate of new HAPI cases. A study by Heerschap et al. (2019) focused on the decision-