Using Alternative Light Source Technology to Enhance the Visual Skin Assessment

Statement of Clinical Problem: The identification of a Deep Tissue Pressure Injury (DTPI) in the early stages of evolution presents a clinical challenge as skin compromise is only visually apparent when evidence of deterioration reaches the outer layers of skin. Impeded visual assessment impacts timely and appropriate intervention and may lead to worsened patient outcomes.  

Description of Past Management: A timely and thorough admission skin assessment is the baseline for capturing pressure injury risk, presence, and in developing an appropriate care plan. Yet, skilled wound clinicians confront the complexities in the early recognition of pressure injury. Skin compromise may be present but not readily apparent.

Current Clinical Approach: In an acute care setting, the certified WOC nurses used alternative light source (ALS) technology to augment the standard visual inspection, offering the potential for an enhanced sensory dimension with regard to distinguishing deep tissue pressure injury. A case study methodology approved by the internal review board (IRB) was used.

Patient Outcomes: Use of the ALS improved the standard visual assessment, revealing wound characteristics and varying nuances not otherwise observable. In 3 cases, what was assumed to be naturally occurring hyperpigmentation or smaller scale DTPI was shown to be larger scale DTPI and breaks in skin integrity.

Conclusions:  The ALS enhanced and defined loss of skin integrity leading to the development and implementation of a more tailored and inclusive plan of care.   Use of an ALS as adjunct to the standard visual skin inspection may promote earlier pressure injury detection, timelier and more effective intervention, decreased morbidity, and cost savings.