The ad that started it all
Last year, the Centers for Medicare & Medicaid Services announced that it would stop reimbursing hospitals for treatment of eight reasonably preventable conditions, including pressure ulcers, in October 2008. That simple announcement has put hospitals across the United States United in a state of anxiety and rightly so. Until now, most hospitals focus on treating pressure sores and the extreme pain and life-threatening infections that follow, rather than preventing them.
This is understandable, since the number of hospitalized patients developing pressure ulcers has increased by 63% in the last 10 years and nearly 60,000 deaths occur annually from hospital-acquired pressure ulcers.
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 hospital-acquired pressure ulcers was 13 days, with an average cost of $37,500 per stay.
Unless hospitals can afford to continue to simply treat pressure sores as they occur without Medicare to subsidize their costs, something must be done. Pressure ulcers can initially develop when the blood supply to a patient’s skin is interrupted for more than two to three hours, or are aggravated by constant pressure on the skin and tissues.
When a patient is immobile or has difficulty moving after surgery or procedures, even minor friction burns created by sheets, wheelchairs, or other surfaces can quickly develop into pressure sores. One problem is that pressure sores can be difficult to identify initially, sometimes appearing as nothing more than a pink or red spot in hard-to-see areas, such as skin folds or bony bumps.
And when they do occur, complications such as bone, blood, and skin infections can quickly develop. Not only the patients suffer; but so do hospitals: treating pressure ulcers often costs more financially and in man-hours than the measures that could have prevented them. That’s not even taking into account the cost of litigation hospitals and care facilities may face for putting their patients at risk when they develop pressure ulcers.
So what can we do? We need to put proactive medicine into practice by transforming our basic pressure ulcer protocols into pressure ulcer prevention programs.
I know what you’re going to say. His center already has a program to identify patients who are at risk of developing pressure ulcers. Maybe you even have a wound management professional to treat patients and instruct your staff on proper procedures. But as hospitals across the country have seen, if pressure sores keep happening, following basic protocols may not be the answer.
For example, Thibodaux Regional Medical Center in Louisiana already had an above-average pressure ulcer rate. But when their quality improvement data detected an increase in the ulcer rate in late 2003, they decided to launch a Six Sigma project to address the issues. After examining the data, they were surprised by the result. They first determined that the tools they had been using to analyze their care were unreliable. Second, some of the preventative measures they were associated with, such as the use of a specific type of patient bed, were not having as positive an effect on patient outcomes as small improvements were.
For example, the way in which the smallest tasks were carried out on the nursing floor. Recommended changes that emerged from the project included simple procedural changes, including reorganizing wound care products in nursing units and creating task lists for CNAs.
Additional solutions included:
- Post a shift schedule in patient rooms to identify need and document patient Q2H shift results.
- Unit educators will address skin issues during annual proficiency tests
- Reports of patient skin problems during shift changes
The result? A sixty percent reduction in the overall rate of nosocomial pressure ulcers, 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 instituted by other hospitals and recreate that success at your own facility.
That’s why our organization has created a database of information on pressure sores, causes, treatments, successful prevention programs, Six Sigma projects, and even products that other facilities and patients have found helpful. It’s a great place to start.
So how do you rate your facility? Can your patient’s pressure ulcer rate be improved? Now is the best time to find out. With a little analysis, research, and a lot of planning and implementation, you’ll be ready and able to provide your patients with the best skin care available. And that’s what good medicine is all about!