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Pressure is On to Reduce Pressure Ulcers

Cheryl Clark, for HealthLeaders Media, November 21, 2013

No longer accepted as "normal complications," pressure ulcers are the target of healthcare leaders who are investing in prevention strategies and seeing results.

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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5 comments on "Pressure is On to Reduce Pressure Ulcers"


David Sutterfield (12/6/2013 at 8:06 AM)
All the Mount Sinai Hospital study seems to state is that the risk of developing a PU increases as the number of co-morbidities increases. That has been known for years. The UTH study noted in this issue makes a case that it is still about relieving pressure and other preventive care, noting they achieved a high rate of success with use of high density foam mattresses. If the MSH study had any validity, then one would not see the wide ranges of outcomes between facilities with bad facilities having consistently bad outcomes and good facilities having consistently good outcomes.

Karen Bry (12/4/2013 at 11:32 AM)
The Wound Care Team at Mount Sinai Hospital in Chicago conducted research investigating the link between hospital acquired pressure ulcer (HAPU) development and co-morbidity. We found that persons who developed HAPU (despite having all recommended prevention)had an average of 9.25 major co-morbid conditions Skin Failure literature discusses the physiology of skin death. Skin Fails too....we need to optimize prevention, invest in the best bed surfaces and prevention devices and ......stop blaming the nurses!

Bonnie Altman (12/4/2013 at 9:51 AM)
PS Hospital Admin. is partially at fault. Hire more nurses and higher quality nurses and nursing staff. Offer better in house edu. ongoing. Put your money and your investment in your nurses and reduce the "need" for unnecessary, prolonged analysis.