New Guidelines SPIPP 2.0: Standardized Pressure Injury Prevention Protocol

New Guidelines SPIPP 2.0: Standardized Pressure Injury Prevention Protocol

Note: The following content abbreviates Pressure Injury as PI.

On June 22, 2023, the National Pressure Injury Advisory Panel in the United States released the Standardized Pressure Injury Prevention Protocol version 2.0 (SPIPP 2.0) and welcomes industry peers for reference! The following content is an introduction to the protocol and its main checklist:

In the context of clinical guidelines, it is increasingly necessary to create a simple, operational version for clinical use, thus, on June 22, 2023, the National Pressure Injury Advisory Panel in Massachusetts released the second edition of the standardized pressure injury prevention protocol, abbreviated as “SPIPP” (pronounced S – PIP). SPIPP is a streamlined bedside prevention entry, with main content adapted from the 2019 Clinical Practice Guidelines for Pressure Injury Prevention and Management.

SPIPP 2.0 is aimed at individuals with limited mobility and severe conditions. The current or anticipated mobility of patients is considered an important risk factor in the SPIPP 2.0 checklist, which is also significant for perioperative patients. Moreover, since mild pressure injuries in individuals with darker skin tones may not be easily detected under insufficient lighting, SPIPP 2.0 emphasizes this aspect to raise awareness and promote its implementation in practice, enhancing protective measures.

SPIPP 2.0 provides clear and concise entries for managing skin cleanliness, moisture, and other aspects. The protocol specifically states that staff should proactively explain the risks of pressure injuries and prevention plans to patients and their families, which helps gain their active cooperation for more timely and adequate prevention outcomes.

According to expert panels from across the United States, the content validity index for SPIPP 2.0 is 0.93. Below are the main entries of the Standardized Pressure Injury Prevention Protocol version 2.0 (SPIPP 2.0):

Standardized Pressure Injury Prevention Protocol Version 2.0 (SPIPP 2.0Standardized Pressure Injury Prevention Protocol

Assessment Items

Completion Status

Evaluation

Assess Pressure Injury (PI) risk factors for prevention guidance

Current or anticipated mobility issues

Use a structured risk assessment method upon admission(such as Braden or other validated risk assessment tools)

Reassess risk factors at each shift and when there are significant changes in condition

Explain pressure injury (PI) risks and prevention plans to patients/families

Other risk factors to consider: history of previous pressure injuries (PI), localized pain, diabetes, poor perfusion, vasopressors, hypoxia, increased temperature, advanced age, spinal cord injury, neuropathy, prolonged surgical/treatment duration >2hrs, severe illness, organ failure, sepsis, mechanical ventilation, medical devices, sedation, darker skin tones

Assess skin/tissue for signs of skin damage and pressure injuries (PI)

Assess skin upon admission and at each shift(comprehensive, visual, palpation) for redness, color changes, swelling, and temperature changes

Assess skin under medical devices at each shift

Check heels at each shift

For individuals with darker skin tones, ensure adequate lighting and moisture/to enhance visual inspection

Consider enhanced skin assessment methodsthermal infrared imaging, SEM skin color charts

Preventive skin caremanage humidity/incontinence

Clean after each incontinence event and use appropriate moisture barriers

Avoid using alkaline soaps/cleansers

For high-risk individuals, consider urine/fecal management systems

Use single-layer, breathable, and highly absorbent pads for incontinence

Consider using low-friction textiles

Use soft absorbent materials in skin folds when appropriate

Pressure Redistribution

For individuals who cannot move independently in bed, turn/reposition every2-3 hours, and consider frequent micro-adjustments unless contraindicated(Braden activity/mobility score ≤2)

For immobile individuals, use high-specification pressure-relieving mattresses(Braden activity/mobility score ≤2)

Use positioning aids to minimize friction/shear(pillows, wedges). Use turning/lifting devices(if available). Correct side-lying position with the upper leg positioned in front of the lower leg

Add local pressure-relieving protective pads or multilayer protective dressings in high-risk areas(i.e. sacrum, lower buttocks, or heels)(Braden activity/mobility score ≤2)

Use pressure-relieving cushions, heel pressure-relieving pads, or specialized heel boots to elevate heels(Braden sensory perception score ≤3)

Ensure adequate repositioning while side-lying(30 degrees). Position the upper leg forward and use a pillow between the legs to support the upper leg

When the overall condition of the individual is unstable, perform slow, gradual, frequent, small adjustments in positioning

For individuals who cannot adequately reposition themselves, when sitting, use pressure redistribution cushions

Sitting patients should change positions at least once every hour, and can also change the direction of weight-bearing to relieve pressure

Consult a physical therapist for an activity plan when appropriate(Braden activity/mobility score ≤2)

Consider prompting systems, pressure monitoring, and movement sensors

Implement early activity plans

Nutrition

Use validated tools for malnutrition screening upon admission

For individuals with existing malnutrition or at risk of malnutrition, reduced nutritional intake,NPO>48hrs or with2 or more stage pressure injuries (PI),(Braden nutrition score ≤2) consult a dietitian

Provide additional calories, protein, fluids, and nutritional supplements(i.e. multivitamins, arginine, glutamine, HMB) based on the nutritional care plan or as needed

Continue to regularly assess goals and consult a dietitian as needed

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