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Pressure is On to Reduce Pressure Ulcers

Cheryl Clark, for HealthLeaders Media, November 13, 2013
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This article appears in the November issue of HealthLeaders magazine.

Just a few years back, hospital-acquired pressure ulcers at 506-licensed-bed Crouse Hospital in Syracuse, N.Y., and other organizations, were "accepted as normal complications" that sick patients are just likely to get, says Chief Quality Officer Derrick Suehs.

"That's the way it was. We'd say, 'Patient Bob has just had surgery and will be lying in bed for five days, and we should watch to see if he gets an ulcer.' We identified these ulcers when they occurred, and then we took care of them."

That attitude is now gone at Crouse, where stage 3 and 4 pressure ulcer rates for the two-year period ending June 30, 2011, were higher than all but 105 other acute care hospitals reporting data, according to spreadsheets prepared by the Centers for Medicare & Medicaid
Services and displayed on Hospital Compare. With 0.671 per 1,000 eligible discharges, Crouse was much worse than the national average of 0.136.

"Today the conversation has changed," Suehs says. "Now it's, 'How do we prevent them in the first place?' It's a different mental framework. We get physicians, nurses, and hospitals to move away from the idea that these are normal complications, so they're okay."

Crouse launched numerous initiatives to reduce all of its preventable hospital-acquired conditions, or HACs, including a control chart that has tracked pressure ulcers at all severity stages by quarter since 2006.

Teams with physician and nurse champions educate frontline staff to be on the lookout for the earliest signs of skin redness at stage 1 or 2. They work with a team of wound ostomy nurses to evaluate patients who might be at higher risk because of the immobility necessitated by their condition or disease or when pain makes movement intolerable.

Patient skin assessments are taken on a daily basis, and a special budget was approved to buy new beds designed to prevent pressure ulcers for the entire hospital. The beds are equipped with mechanisms to relieve pressure on heels and elbows. Crouse also rents special mattresses embedded with air and water that staff use to easily shift patients' positions to relieve pressure.

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