Onboarding The Nurse In The Diagnosis Of Moisture Associated Skin Damage Vs. Pressure Injury

Moisture associated skin damage (MASD) is frequently mistaken by nurses for pressure injuries (PI). Like MASD, PI may occur at the gluteal cleft or buttocks, however MASD is derived from moisture and is often associated with feces, urine, and perspiration. On the other hand, PI are caused by pressure and ischemia, occurring over soft tissue, bony prominences, or from medical devices. Interventions for MASD are markedly different for PI and strict attention to improving them are important since having a MASD injury heightens the risk of and may lead to the development of a PI (Woo, et al., 2017). Failing to correct MASD has serious nursing implications. Considering Centers for Medicare and Medicaid’s ruling to not reimburse for certain PI, mismanaged MASD wounds which progress to Stage III or IV PI could be costly to a healthcare facility. There is also the risk of litigation by patient and family members who may blame a healthcare facility for wounds perceived to be improperly managed.

A WOC nurse in an acute care facility developed a program to educate staff nurses to recognize the differences between MASD and PI. Six staff nurses volunteered to participate in a pilot study to evaluate and care for patients consulted for MASD and PI. A pre-care huddle included instructions on the etiology, similarities, and contrasting features of each wound; this was supported by a graphic evidenced-based display of the wounds in a power point slide. During post-care huddle, nurses reflected on their findings and verbalized key characteristics of the wounds.

Having nurses identify the differences and similarities between MASD and PI, improved diagnosis and treatment and led to better outcomes within six months of the program’s inception. Because of the successful pilot, nursing education has implemented this program to educate nurses throughout the entire institution.