Pressure Ulcers v Deep Tissue Injury vs Blisters ll

Afte publishing the post about Pressure Ulcers v Deep Tissue Injury vs Blisters I received an excellent email from Sue Hull, MSN, RN, CWOCN, who operates WoundConsultations.com
"The reason DTI is discussed along with pressure ulcers in the NPUAP document is because it is caused by pressure. If it occurs while a person is a resident of a nursing home, it would indicate negligence in that the measures had not been taken to prevent pressure. I believe it is standard care that a pressure ulcer risk assessment is done on admission and at predetermined intervals thereafter in nursing homes (as in home health, where I work). Based upon the findings of the risk assessment, interventions are to be implemented to prevent skin breakdown. If DTI develops, something was missed in the process, or something is wrong with that particular nursing home's process.

If there were factors that truly did make the DTI unpreventable, those factors should be copiously documented. It should never be a surprise when a pressure ulcer develops. Eg. if a resident MUST have the head of the bed in a high Fowler's position to breathe, it should be heavily documented along with the skin assessment, and a sacral DTI should be watched for. It should not be a surprise.
Also, when there is DTI, it is not undectible, even in persons of color. There are changes, such as warmth, bogginess, blood filled blisters, and color changes. If boney prominence are routinely checked for these things, the DTI will be detected."
Thanks for your input Sue.

http://malpractice.blogspot.com/2011/11/pressure-ulcers-vs-deep-tissue-injury.html