b'California (USC) in Los Angeles, said that the U.S. healthcare system spends $1 million on PIs every 20Even without the challenges of minutes. spinal cord injuries or rugged ThefinancialresourcestoimplementSPIPPare what the VA appropriations bill covers, added Padulaenvironments for initial care, and his NPIAP colleagues. There are separate budgetveterans run a significant risk items in this large bill to pay for personnel for itemsof acquiring PIs in hospitals and beyond PI care, such as medication management and infection control. This type of budgeting helps PI carenursing homesand both the VA be financially sustainable in VA facilities. and Congress have taken note.Multiple Ways to Reduce PIsThe VA began focusing on reducing pressure injuries well before the recent funding and continues to intro- [facility-associatedpressureinjury]rates,the duce a variety of measures to prevent these wounds.researchers said. A team at the VA National Center for Patient Safety atPadula said the biggest game-changers since the White River Junction, VT, and the VAs Pressure InjuryInternational Guidelines were published in 2019 PreventionandManagementteaminWashington,aresub-epidermalmoisturescanningtopredict DC, introduced a 12-month virtual breakthrough se- cellulardeformationbeforeskindamageoccurs ries (VBTS) collaborative to tackle PI prevention inand that timing of repositioning of patients does 2016 and then expanded the program to 28 acute andnotneedtobelessthanfourhoursifpatients long-term care facilities in the VHA. 4 are moved consistently. A recent study of 1,100 The program included the VA SKIN Bundle and apatients in nursing homes found that cueing staff project workbook. The VA SKIN bundle includedto reposition patients by using a wireless patient assessing skin and risk status on admission and peri- monitoringsystemthatdisplayedtheneedfor odically afterward, using select surfaces and devicesrepositioningonmonitorsledtoPIsdropping to relieve pressure, turning and repositioning, incon- from 5.24% to zero, and that compliance was best tinencemanagementandnutritionandhydration(95%) at four-hour intervals. 5assessment and intervention. 1Champagne PT, Tzen YT, Wang J, Bennett B, Van Beest D, Tan WH. Those step match well with the NPIAPs SPIPPPredictors of one year pressure injury outcomes in hospitalized spinal which emphasizes assessment of risk and skin tis- cord injured veterans with one stage 3 or 4 pressure injury. J Spinal sue,preventiveskincarebymanagingmoistureCord Med. 2023 Feb 6:1-7. doi: 10.1080/10790268.2022.2158290.andincontinence,redistributionofpressureand2Bridges E, Whitney JD, Burr R, Tonentino E. Pressure Injury Mitiga-nutrition.tion in Prolonged Care: A Randomized Noninferiority and Superiority Each facilitys team had some flexibility in choos- Trial, Military Medicine, 2023 April; usad121. ing the interventions they would implement. The3Padula WV, Black JM, Garcia A, Mishra MK. Congress Takes a Posi-tive Swing at an Unsung Public Health Crisis: Preventing Pressure teamsimplemented23uniqueinterventions,10Injuries in Veterans Affairs Facilities. Adv Skin Wound Care. 2023 of them from the VA Skin Bundle, with each teamMar 1;36(3):123-124. doi: 10.1097/01.ASW.0000903964.14644.66.selectinganaverageoffourinterventions. After4Zubkoff L, Neily J, McCoy-Jones S, Soncrant C, Young-Xu Y, Boar education,themostcommoninterventionsintro- S, Mills P. Implementing Evidence-Based Pressure Injury Prevention duced were bedside steps such as use of pressure- Interventions: Veterans Health Administration Quality Improvement Collaborative. J Nurs Care Qual. 2021 Jul-Sep 01;36(3):249-256. doi: relievingboots,specialtymattressesanddevice10.1097/NCQ.0000000000000512.dressings.5 Yap TL, Horn SD, Sharkey PD, Zheng T, Bergstrom N, Colon-The aggregated rate of PIs declined from 1.0 toEmeric C, Sabol VK, Alderden J, Yap W, Kennerly SM. Effect 0.8 per 1,000 bed days. In the long-term care units,of Varying Repositioning Frequency on Pressure Injury Preven-thePIratesdropped50%,from0.8to0.4pertion in Nursing Home Residents: TEAM-UP Trial Results. Adv 1,000 bed days. Clinically focused changes at theSkin Wound Care. 2022 Jun 1;35(6):315-325. doi: 10.1097/01.bedsidemaybewhatcontributedtothereducedASW.0000817840.68588.04.44'