The message that started it all
Last year, the Centers for Medicare and Medicaid Services announced that they will stop reimbursing hospitals for the treatment of eight reasonably preventable conditions – including pressure ulcers – in October 2008. The simple announcement has put hospitals across America in a state of apprehension and with good reason. Until now, the majority of hospitals focus on treating pressure ulcers and extreme pain and life-threatening infections that follow, rather than preventing them.
Which is understandable as the number of hospital patients developing pressure ulcers has increased by 63% over the past 10 years, and nearly 60,000 deaths occur annually from the hospital’s acquired pressure ulcer.
But that is not the only toll. According to the Agency for Healthcare Research and Quality, the average stay for patients admitted to the hospital for treatment of the hospital’s acquired pressure ulcer was 13 days at an average cost of $ 37,500 dollars per stay.
Unless hospitals can afford to continue simply treating pressure ulcers as they appear without Medicare to subsidize their costs, something needs to be done. Pressure ulcers may initially develop when the blood supply to a patient’s skin is cut off for more than two or three hours, or exacerbated by constant pressure on the skin and tissue.
When a patient is moving or having difficulty moving after surgery or procedures, even the smallest friction burns created by sheets, wheelchairs or other surfaces can quickly be converted into pressure ulcers. One problem is that pressure ulcers can initially be difficult to identify, sometimes it looks like something other than a pink or red spot on hard-to-see areas such as skin folds or leg protrusions.
And when they do occur, complications such as bone, blood and skin infections can quickly develop. Not only do patients suffer; but so do hospitals – treating pressure ulcers often costs more economically and in staff hours than the measures that could have prevented them. This does not even take into account the cost of litigation that hospitals and care facilities can face because they expose their patients when pressure ulcers occur.
So what can we do? We need to put proactive medicine to work by transforming our basic pressure ulcer protocols into pressure ulcer prevention programs.
I know what you want to say. Your facility already has a program to identify patients at risk of developing pressure ulcers. Maybe you even have a wound care provider to treat patients and instruct your staff on proper procedures. But as hospitals across the country have seen, if pressure ulcers still occur, that may not be the answer to basic protocols.
Eg. Had Thibodaux Regional Medical Center in Louisiana already had a better than average pressure ulcer. However, when their quality improvement data detected an increase in wound rate in late 2003, they decided to start a Six Sigma project to solve the problems. After examining the data, they were surprised by the result. First, they determined that the tools they had used to analyze their care were unreliable. Second, some preventive measures they relied on, such as using a specific type of patient bed, did not have as much of a positive effect on patient outcomes as small improvements.
Eg. How minor tasks were done on the nursing floor. The recommended changes that came out of the project included simple procedure changes, including reorganization of wound care products on care units and the creation of task lists for CNAs.
Additional solutions included:
- Posting a turnaround in patient center to identify needs and document outcomes of patient Q2H turnaround.
- Device teachers to tackle skin problems during the annual competency test
- Reporting on the patient’s skin problems during shift changes
The result? A 60 percent reduction in total gastric ulcer in nosocomial pressure with an annual cost avoidance of about $ 300,000. The best way to create and implement a new pressure ulcer prevention program is to model the successful programs put in place by other hospitals and restore that success in your own facility.
Therefore, our organization has created a database of information on pressure ulcers, causes, treatments, successful prevention programs, six sigma projects and even products that other facilities and patients have found useful. It’s a good place to start.
So how does your facility fare? Can your patient’s pressure ulcer improve? Now is the best time to find out. With a little analysis, research and a lot of planning and implementation, you are ready and able to provide your patients with the best available skin care. And that’s what good medicine is all about!