The Announcement That Started It All
Last year, the Centers for Medicare and Medicaid Services announced that it will stop reimbursing hospitals for treating eight reasonably preventable conditions – including pressure ulcers – in October 2008. That simple announcement has put hospitals across America into a state of anxiety and with good reason. Up until now, the majority of hospitals focus on the treatment of pressure ulcers and the extreme pain and life-threatening infections that follow, rather than preventing them.
Which is understandable, since the number of hospital patients who develop pressure sores has risen by 63% over the last 10 years and nearly 60,000 deaths occur annually from hospital-acquired pressure sores.
But that’s 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 sores was 13 days, with an average cost of $37,500 dollars per stay.
Unless hospitals can afford to continue simply treating pressure sores as they occur without Medicare to subsidize their costs, something must be done. Pressure sores can initially develop when the blood supply to a patient’s skin is cut off for more than two or three hours, or is aggravated by constant pressure on the skin and tissues.
When a patient is immobile or has difficulty moving after surgery or procedures, even the slightest friction burns created by bed sheets, wheelchairs or other surfaces can quickly turn into pressure ulcers. One problem, is that pressure ulcers can initially be hard to identify, sometimes looking like nothing more than a pink or red spot on hard to see areas like skin folds or bony 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 sores often costs more financially and in personnel hours than the measures that could have prevented them. That doesn’t even take into account the cost of litigation hospitals and care facilities can face, for putting their patients at risk when pressure ulcers develop.
So what can we do? We need to put proactive medicine to work by transforming our basic pressure sore protocols into pressure ulcer prevention programs.
I know what you’re going to say. Your facility already has a program in place to identify patients who are at risk to develop 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 ulcers are still occurring, following basic protocols may not be the answer.
For example, Thibodaux Regional Medical Center in Louisiana already had a better than 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 at the outcome. First they determined that the tools they had been using to analyze their care were unreliable. Second, some preventative measures they relied upon, like using a specific type of patient bed, wasn’t having as much of a positive effect of patient outcomes as small improvements had.
For example, the way smaller tasks were performed on the nursing floor. The recommended changes that came out of the project included simple shifts in procedure including reorganization of wound care products on nursing units and creating task lists for CNAs.
Additional solutions included:
- Posting a turning schedule in patient rooms to identify need and document results of Q2H turning of patient.
- Unit educators to address skin issues during annual competency testing
- Reporting on patient skin issues during shift changes
The result? A sixty percent reduction in the overall nosocomial pressure ulcer rate, 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 in your own facility.
That’s why our organization has created a databank of information on pressure ulcers, causes, treatments, successful prevention programs, six sigma projects and even products other facilities and patients have found helpful. It’s a great place to start.
So how does your facility rate? Can your patient’s pressure ulcer rate be improved? Now is the best time to find out. With a little analysis, research and a good deal of planning and implementation, you’ll be ready and able to give your patients the best skin care available. And that is what good medicine is all about!