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Pressure is On to Reduce Pressure Ulcers

Cheryl Clark, for HealthLeaders Media, November 21, 2013

One important action is to make sure that nursing and admitting staff correctly code patients who arrive at the hospital with an existing pressure ulcer; coding the pressure ulcer as present on admission will help ensure that Crouse is not blamed for causing it, says Jennifer Watkins, Crouse's director of quality improvement.

"Especially with patients coming from a nursing home, for example, if we don't take the opportunity to do a full assessment in the beginning, a pressure ulcer may appear to be a hospital-acquired condition, when in fact the patient came in with skin already starting to break down," Watkins, says.

And Crouse's rates of severe decubitus ulcers are dropping. Hospital officials say the latest update shows Crouse's rates of pressure ulcers at 0.447. It's not zero yet because the rolling evaluation period still captures the time frame when Crouse's pressure ulcer rates were higher.

At Adventist Sonora (Calif.) Regional Medical Center, which has 72 acute care beds, pressure ulcer rates were almost as high those at Crouse for that period, at 0.645 per 1,000 eligible discharges. Sonora Regional had the distinction of having the 114th highest number of pressure ulcers on Hospital Compare.

"We recognized we had a problem," says Dixie Hukari, Sonora's executive director of quality management. "But with a number of interventions, we haven't had a patient with a hospital-acquired stage 3 or stage 4 pressure ulcer since May 2011."

They initiated turning schedules, began using moisture barriers for vulnerable parts of patients' skin surfaces, and initiated a campaign called the PUP, or Pressure Ulcer Prevention, program.

How hospitals deal with severe bedsores and seven other HACs from the Agency for Healthcare Research and Quality PSI-90 list is increasingly important. They're now folded into two pay-for-performance programs under the Patient Protection and Affordable Care Act. The AHRQ PSI-90 counts for 35% of the 1% Medicare base DRG hospital-acquired condition penalty, and counts for about 6% of the value-based purchasing incentive program, provided that the hospital has a minimum number of cases for all measures in the equation. Poorly performing hospitals will see downward adjustments to their reimbursements starting Oct. 1, 2014.

To be sure, it's a bad thing for a hospital like Sonora, which serves a large retirement community, if there's a penalty for having too many pressure ulcers and other preventable HACs. It means a loss of important revenue, Hukari says.

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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.