Many patients in the height of the pandemic found themselves playing an unfortunate waiting game. They waited in their car until they could be triaged in the ER, waited in the ER for days to be admitted, waited to receive consultations or treatments due to the strain on the healthcare system. Often, this waiting — particularly in ER beds — led to issues with their skin. Of the 14 most common hospital-acquired conditions, pressure wounds are one of only two that have recently increased.
Pressure wounds, also known as bed sores or ulcers, increased in hospital settings during the pandemic due to increased patient loads and isolation protocols, which led to fewer in-room patient visits and less attention to positioning as well as proning for those with the most severe cases of COVID.
The solution can largely be found in proper nutrition — an essential component in disease prevention and treatment that is often overlooked in the acute care environment. Nutrition is vitally important to wound prevention and care, and dietitians play a key role in ensuring patients receive the proper nourishment to not just recover but thrive.
Consulting dietitians for better wound prevention, healing
While it’s true that hospitals are not built for the patient volume they faced at the height of the pandemic, there are workable ways to address pressure wounds, particularly by bringing dietitians on board in patient care early and often. Dietictians, for example, can:
Conduct physical examinations of patients in holding. A nursing nutrition screening should be completed within 24 hours of admission. However, with increased ER wait times, a truly thorough physical exam is often overlooked. Ensure all patients have a thorough physical exam, especially when wait times are longer for admission.
Honor patient food preferences. Keep in mind that in cases of low body weight, poor appetite and malnutrition, it’s helpful to liberalize the patient’s diet to allow for more choices. Of course, dysphagia parameters must be followed — however, in the absence of dysphagia, patient preferences should be honored to improve oral intake.
Advise when NPO (nothing by mouth) is actually necessary. There’s little evidence to support keeping patients on NPO for many hours prior to surgery. In fact, there’s more evidence that suggests prolonged fasting can have detrimental effects such as hypoglycemia, dehydration and falls, especially in those who are elderly or malnourished.
Help with feeding tube placements. Many advanced practice nutrition support dietitians have added nasogastric and small bowel feeding tube placement to the scope of their responsibilities. With recorded competencies, dietitians can perform these placements instead of doctors and nurses, serving as another resource to place tubes quickly.
Additionally, hospitals should consider relying on technicians or trained students to physically rotate patients to avoid pressure wounds. Allow nurses to perform at the top of their license and let staff assist with less specialized tasks.
Food for thought: Better integrating dietitians into the patient care plan
Dietitians play an essential role not just in wound prevention and treatment but across the entire continuum of care. More broadly integrating them into the acute care setting is a cost-effective move that betters patient outcomes — for example, we found involving a dietitian in patient care early and preventing just three Stage III pressure injuries would equate to the annual cost of their salary. There are simple ways to expand dietitians’ roles in the diagnosis and treatment process, such as:
Include dietitians in patient rotations. Often, healthcare providers do not directly involve dietitians in assessing patients’ nutritional needs or ordering the appropriate diet or nutrition support method. By including dietitians early in admission, the proper diet or nutrition support method will be initiated faster.
Give dietitians ordering privileges. Right now, ordering privileges for dietitians vary state to state, and this inconsistency under utilizes their expertise. The last thing an overloaded physician wants to deal with is having to order an oral nutrition supplement for a patient.
The old saying goes, an ounce of prevention is worth a pound of cure. That’s certainly true when it comes to nutrition. By making dietitians a key part of the clinical team, we can ensure that patients receive the best care — and information — possible.
About the authors:
Jordan Bergloff: As a senior portfolio executive on the Vizient Food Team, Jordan Bergloff leverages her food service and clinical nutrition background to manage a portfolio of agreements. She has over 10 years of experience in food and nutrition services in the acute care setting. She served as food and nutrition services director and clinical dietitian and is an RD with her MBA.
Tearah Ott: In her role as sourcing director at Vizient, Tearah Ott combines her clinical expertise and industry experience to leverage Vizient solutions that drive industry-leading contract value. She is responsible for managing the skin and wound contract portfolio as well as leading the Vizient Member Wound Care Contracting Council. Her background includes value analysis experience and clinical practice in neonatal and newborn care.
Christina Wright: As a senior portfolio executive on the Vizient Food Team, Christina Wright leverages her food service and clinical nutrition background to manage a portfolio of agreements in the food category. She brings 20 years of experience in food and nutrition services in the acute care setting to her role at Vizient. For the past 10 years, she served as Food and Nutrition Services Director in multiple hospitals. Wright is an RD with her MBA.