Pay-for-performance programs and value-based purchasing incentives, along with intensified public reporting practices, are changing the way hospitals nationwide are addressing certain healthcare-associated conditions including pressure ulcers. According to an article published in Health Leaders magazine, hospitals are no longer looking at severe bed sores as "normal complications" to be accepted as par for the course when faced with certain illnesses and extended hospital stays.
In the article, "Pressure is On to Reduce Pressure Ulcers," healthcare leaders from Crouse Hospital (Syracuse, N.Y.), Adventist Sonora Regional Medical Center (Senora, Calif.) and WellStar Cobb Hospital (Austell, Ga.) discuss the steps their facilities are taking to transition from a reactive to a proactive approach to combating bed sores. Instead of waiting for wounds to develop and then trying to determine a treatment protocol, these hospitals are working hard to prevent pressure ulcers from ever developing in the first place.
With 0.67 pressure ulcers per 1,000 eligible discharges, Crouse Hospital actually had one of the highest pressure ulcer rates in the country but has seen drastic improvement since the implementation of its interventions. Similarly, since the launch of Adventist Sonora's PUP (Pressure Ulcer Prevention) campaign, this facility has not had a patient with a hospital-acquired stage 3 or stage 4 pressure ulcer since May 2011.
Doctors at Johns Hopkins Medical Center have implemented an Early Mobility Program designed to get patients in intensive care units up and moving as soon as possible. In addition to preventing bed sores, this program, which is even being utilized with patients on ventilators, has proven to help build muscle strength and reduce pulmonary complications.
The following strategies, which these hospitals have found beneficial in preventing pressure ulcers, were discussed in the article:
- Encourage front line staff to watch closely for the earliest signs of skin redness. Early detection -- at stage 1 or stage 2 -- is key.
- Increase the number of wound care nurses and provide more education and training to nursing support staff.
- Perform daily skin assessments and intensify attention given to high risk patients. For example, establish a team of wound ostomy nurses charged with evaluating patients who might be at higher risk due to lessened mobility.
- Utilize moisture barriers on vulnerable areas of patient skin surfaces. Some hospitals are finding that a silicon-based foam dressing protects the skin well.
- Establish adequate turning schedules.
- Invest in specially designed beds and mattresses. Beds can come equipped with mechanisms to relieve pressure on heels and elbows while special mattresses, pumped with air and water, can make shifting a patient's weight much easier.
- Analyze event data to determine any trends in the location of wounds. You may be able to conclude that a certain type of equipment is rubbing sores on patients. If so, an equipment change may be in order.
- Improve documentation of sores. Your facility should not be blamed for conditions it did not cause. So, make sure that wounds present on admission are coded accurately.
- Assess and monitor patient nutrition. Better nutrition speeds the healing process.
To download the Agency for Healthcare Research & Quality's Toolkit for Preventing Pressure Ulcers in Hospitals, click here.