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UNMC helps develop guidelines for pressure injury care in COVID-19 patients

Image with caption: From left, Janet Cuddigan, PhD, and Joyce Black, PhD

From left, Janet Cuddigan, PhD, and Joyce Black, PhD

Health professionals are discovering new ways to help hospitalized patients who contract severe forms of coronavirus.

UNMC College of Nursing faculty members Joyce Black, PhD, and Janet Cuddigan, PhD, are experts in the prevention and treatment of pressure injuries -- also called pressure ulcers, pressure sores and bed sores. Health professionals are seeing increased cases of this condition in patients hospitalized for long periods of time with COVID-19.

Pressure ulcers can cause death if not properly managed.

Drs. Black and Cuddigan serve on the board of the National Pressure Injury Advisory Panel (NPIAP) as secretary and president, respectively. Dr. Black also is a past president of the NPIAP.

The panel provides leadership to improve patient outcomes in pressure injury prevention and management through education, public policy and research.

"As COVID-19 was rearing its ugly head, people sent out notices of concern about prevention and treatment of pressure injuries," Dr. Cuddigan said. "New challenges are undeniable with COVID-19. We've hearing from colleagues across the country."

Early in the outbreak, health care professionals discovered that putting patients in a prone position -- on their stomachs -- in the intensive care unit helped improve oxygen levels, something that has been done in the ICU for years, Dr. Cuddigan said.

However, it's not widely known how to prevent pressure injuries in that position.

The NPIAP put together information on how to get patients into position safely and care for them in the prone position. The panel has drawn on information from those with the most experience with COVID-19 -- health care workers in New York, New Jersey and Boston.

"We're making a national and international impact and are collaborating in Nebraska and beyond," Dr. Cuddigan said.

The panel is getting calls from such organizations as the Veterans Administration, which shared the information throughout its system, and Massachusetts General Hospital.

Drs. Black and Cuddigan and their NPIAP colleagues also developed a position statement on the best care of the skin and guidelines on how to use masks safely.

"We're still seeing some of the effects of long wear of masks" on health care providers, said Dr. Black, who recently was appointed to an international panel to address the problem.

Position paper

The National Pressure Injury Advisory Panel also developed a position paper noting that skin changes in patients with COVID-19 may not be pressure injuries. It's important because in normal circumstances, Medicare and Medicaid consider them medical errors and therefore not reimbursable to the hospital.

Information on COVID-19 skin changes has been published in a peer reviewed journal and has been translated into six different languages. The authors collaborated with Ashley Wysong, MD, and say it's been an advantage to listen to debriefings of shared experiences from health professionals at UNMC and Nebraska Medicine, who have internationally recognized expertise in the care of patients with highly infectious diseases.

Dr Wysong is the UNMC William W. Bruce, M.D. Distinguished Chair of Dermatology.

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