A pressure ulcer is an injury to the skin and/or the underlying subcutaneous tissue and muscle caused by pressure from body-weight often combined with friction. They are also referred to as "bed sores", but that term is limiting, because pressure ulcers can occur in wheelchair-bound people as well.
According to the Agency for Healthcare Research and Quality (AHRQ), pressure ulcers increased by 80% between 1993 and 2006. Despite increased understanding of pressure ulcers and several guidelines published to aid caregivers in preventing them, the incidence grows. The Centers for Medicare & Medicaid Services (CMS) have taken notice. In Section 5001(c) of the Deficit Reduction Act of 2005, the Secretary of Health and Human Services was ordered to identify conditions that are high cost or high volume (or both), result in a higher payment when present as a secondary diagnosis, and could have been prevented if evidence-based guidelines were followed. As a result, the CMS included 10 categories of healthcare-acquired conditions in the Inpatient Prospective Payment System (IPPS) Fiscal Year 2009 Final Rule that would not provide Medicare reimbursement to a hospital at the higher rate for the identified healthcare-acquired conditions. Stage III and IV Pressure Ulcers made the list.
This has become a noticeable incentive for hospitals especially to pay attention to pressure ulcer prevention guidelines. According to the AHRQ's research, in 2006 pressure ulcers were the primary diagnosis at admission in about 45,500 cases. However, pressure ulcers were a secondary diagnosis 457,800 times. It is in exactly these secondary diagnoses that hospitals now must absorb more of the cost without the aid of government reimbursement.
And the costs are considerable. The average hospital stay that involves a pressure ulcer is 2 to 3 times longer than the average hospital stay that does not involve a pressure ulcer. The cost per patient with pressure ulcer can be as high as double the cost of a non-pressure ulcer related hospital stay. Nor are pressure ulcers merely a cost nuisance. The AHRQ's data analysis discovered that about 1 in 25 patients with a pressure ulcer as the primary diagnosis upon admission ended in death. When pressure ulcer became the secondary diagnosis, the death rate soared to 1 in 8.
Pressure Ulcer Prevention Guidelines
The Institute for Healthcare Improvement has published guidelines consisting of 6 components of care to prevent pressure ulcers. These guidelines should provide an effective response to the CMS's goal of incentivizing hospitals to reduce the incidence of this particular healthcare-acquired condition because the process is based on evidence of successful impact. Most pressure ulcers are preventable. By following the IHI's guidelines, and by using the tools that medical supply and equipment manufacturers have created, the coming years will hopefully record fewer cases of this avoidable condition.- Assess patients for pressure ulcer, and pressure ulcer risk, upon admission.
- Reassess patients daily for pressure ulcer risk.
- Inspect skin daily.
- Products to help:
- Repositioning aids to help staff avoid injury
- Repositioning straps and belts
- Repositioning mats and blankets
- Patient Transfer Boards
- Patient lift equipment(such as portable or ceiling-mounted)
- Products to help:
- Manage moisture. Keep the patient dry and moisturize the skin.
- Products to help:
- Skin Care Creams
- Skin Care Ointments
- Skin Cleansers
- Skin Protective Barrier Lotions
- Absorbent briefs and pads can be effective in managing the moisture due to incontinence, but it is important for staff to change these frequently so that the moisture does not stay close to the patient's skin. Some manufacturers have patented drypads that lock in wetness within seconds. Some of these products are also air-permeable. Other features to consider: films that provide leakage protection, tear-resistance, heavy-duty weight support, and even antimicrobial properties to inhibit the growth of bacteria and yeasts that can cause odors.
- Products to help:
- Ensure the patient has optimized nutrition and hydration.
- Redistribute pressure.
- Products to help:
- Mattresses that provide alternating pressure
- Foam pads to redistribute pressure
- Foam and gel cushions
- Products to help:
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