MDS Alert

Your SNF can take a simple step to prevent this serious problem.

Before you conclude that a wound in the hip area has been caused by pressure, consider the possibility that IM injections may have caused the problem.

Key clues: "Many times, if you ask the patient, they will tell you that they had a shot" that hurt very badly, says Terry Treadwell, MD, medical director for the Institute of Advanced Wound Care in Montgomery, Ala. Also take a look at the wound's location. "IM injections are usually given in the buttock area, but not over a bony prominence," he says.

When assessing a wound caused by an IM injection, "you will often find a hard knot. By the time the person gets to a wound-care specialist, however, they may have a large, hard area with black eschar," Treadwell tells MDS Alert. In treating the wound, you'd debride the necrotic tissue and maintain a moist wound environment, he says.

For more information, read an article by Treadwell, "Intramuscular Injection Site Injuries Masquerading As Pressure Ulcers," published in Wounds (www.woundsresearch.com/article/2045). Two of the patients discussed in the article required surgical intervention to resolve their non-healing "bed sores." In one case, the patient had no obvious wound on the surface, Treadwell says. But "an MRI showed an area of necrosis deep in the tissues. We had to operatively drain and debride the area," he adds.

Preventive tips: The article includes a table with tips for administering IM injections as safely as possible. The best bet is to avoid IM injections. Treadwell advises providers to give medications by mouth, or IV, rather than IM, to avoid any potential problem. As for medications that tend to cause such wounds, the long-acting injectables are "some of the biggest offenders today," according to the literature, Treadwell says.