Behind the Care: 3 Things TMH Did to Help Reduce Pressure Injuries

Pressure injuries can begin quietly. For some patients, especially those who are sick, unable to move easily or living with multiple health conditions, a small area of pressure on the skin can become a serious wound. These injuries, sometimes called bedsores or pressure ulcers, often develop when pressure reduces blood flow to the skin and tissue underneath. They can happen on parts of the body where bone is close to the skin, such as the heels, tailbone, hips, elbows or back of the head.

At Tallahassee Memorial HealthCare (TMH), reducing the likelihood of pressure injuries has been an important focus of ongoing quality work. While not every pressure injury can be prevented, especially in patients with complex medical conditions, multiple teams within TMH have worked together to identify risks earlier, improve prevention efforts and respond quickly when concerns arise.

Here are three ways TMH has worked to reduce pressure injuries and improve patient care.

1. Use data to drive quality

TMH teams regularly monitor trends across a wide range of patient safety measures, including pressure injuries. When team members saw a change in pressure injury data, they took a deeper look at workflows, equipment, documentation and care processes to better understand where improvements could be made.

That work was brought to TMH’s Clinical Leadership Committee, a physician-led, collaborative group that includes nursing, information systems, pharmacy, quality, risk management and other key clinical stakeholders. From there, a focused pressure injury team was created to help drive changes across the hospital.

For any pressure injuries that may have occurred within the hospital, the team conducts a root cause analysis, which is a structured review designed to understand what happened, what factors may have contributed and what could be done differently in the future.

That process is not about one person or one moment. It is about learning from each case and strengthening the systems around patient care.

2. Improve tools, equipment and care processes 

Pressure injury prevention depends on many small, consistent actions. Patients most at risk for pressure injuries may need help changing positions, protecting bony areas, keeping their heels off the bed, improving nutrition, using special dressings or receiving care from wound care specialists. The goal is to prevent pressure from building in one area for too long and to catch early skin changes before they become more serious.

As part of this work, TMH optimized its orders, documentation and nursing workflows. The goal was to help nurses spend less time navigating documentation and more time caring for patients.

The supply chain team was also involved to ensure patients had access to better protective foam dressings. Clinical staff found that some products were less effective and required more frequent replacement. Using better-performing dressings helped support patient care and improve efficiency.

Another major improvement was replacing the mattresses on medical-surgical floors with newer, more advanced mattresses. These mattresses offer better pressure-relieving support and can be connected to low-air-loss pumps when needed. The pumps help move air through the mattress and can assist with turning support, which helps nurses reposition patients more safely and effectively. These tools do not replace hands-on care, but they provide care teams with better proactive support when caring for patients at higher risk.

3. Strengthen education and teamwork

Preventing pressure injuries takes a team. Nurses are often the first to notice changes in a patient’s skin. Physicians help place the right orders and involve wound care when needed. Wound care nurses assess wounds, stage them, recommend dressings and create a plan of care. Dietitians help address nutrition needs, which are closely tied to wound healing. Physical and occupational therapists support mobility. Case managers help coordinate care after discharge, including home health or outpatient wound care when appropriate.

At TMH, education has been a key part of this work. Physician engagement has also been important. Chris DeRosier, MD, TMH’s physician champion for reducing pressure injuries, has helped reinforce the importance of early wound care involvement and consistent prevention efforts among physician groups.

Dr. DeRosier, who also serves as TMH’s Medical Director of soft tissue services and chairs TMH’s Multidisciplinary Review Committee, largely credits the decrease in pressure injuries to organization-wide dedication, which included designating pressure injury champions at every level, from administration to physicians to nursing staff.

“When you drill down to how we decreased pressure injuries, it was really about reaffirming our culture of making patient safety a priority,” Dr. DeRosier said. “Our improvements don’t exist in isolation, it happens as we continually improve the quality of services we deliver for managing skin and soft tissue complications.”

Dr. DeRosier emphasized that prevention efforts now can lead to expanded care at TMH in the future.

“Not only have we worked hard to prevent these injuries,” Dr. DeRosier said. “We’ve now established ourselves as a referral center and treat patients from outside of our institution sent to us from areas such as Jacksonville, Panama City Beach and Macon.” 

For local patients who are coming to TMH for emergent issues, the emergency department and trauma teams have also become more involved in early identification and prevention.

Who is most at risk for pressure injuries?

Pressure injuries can affect anyone, but they are more common in people who have difficulty moving or cannot reposition themselves. Patients who are intubated, sedated, wheelchair-bound, bedbound or recovering from trauma may be at higher risk. So can patients with diabetes, poor circulation, cancer, stroke, spinal cord injuries, dementia, poor nutrition, feeding tubes, obesity or advanced age. 

In some cases, pressure injuries can begin developing in as little as two hours, especially when pressure is combined with poor circulation, fragile skin or serious illness.

If not treated early, pressure injuries can lead to significant complications, including infection, bone infection, sepsis, surgery or other long-term wound care needs. For some patients, especially those who are frail or not candidates for surgery, these wounds can become extremely serious.

That is why prevention, early recognition and teamwork matter.

We care everywhere

TMH’s progress in pressure injury prevention reflects a larger commitment to quality throughout our entire organization. It is not the result of one change, one person or one department. It comes from many teams looking closely at the data, improving tools and processes, educating staff and taking action at the bedside every day.

For patients and families, that means TMH teams are working to identify risks earlier, prevent wounds when possible, and respond quickly when pressure injuries do occur. It is one way TMH is focused on getting better every day — through thousands of small decisions that add up to safer, stronger care.

Learn more about what TMH is doing to provide the highest quality care to its patients at TMH.ORG/WeCareEverywhere