Promoting Skin Integrity:Pressure Ulcer Prevention

December 8, 2009

Stratis Health• Stratis Health is a non-profit organization that

leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facility improvement for people and communities

• Under federal contract, Stratis Health serves as Minnesota’s Medicare Quality Improvement Organization (QIO) 

• Stratis Health is also involved in other state and national projects funded through government contracts, foundation and corporate grants, and health systems

• www.stratishealth.org

Objectives• Recognize the impact a pressure ulcer has on the

overall health and well-being of an individual.• Describe key components of a comprehensive skin

integrity program.• Share with your organization:

– Two practical strategies for implementing a pressure ulcer prevention program

– One idea for monitoring your pressure ulcer prevention program to ensure it is meeting the goals of the program

• Identify three resources for up-to-date pressure ulcer prevention and treatment strategies.

Housekeeping

• Packet- includes agenda and presentation handouts • Restrooms• Lunch• Who is in the room?• Meet everyone at your table. What are you hoping to

get out of today?• Cross setting efforts – seating arrangements• Resource table

WHY ARE WE STILL TALKING ABOUT PRESSURE ULCERS?

What Do We Know?

• The prevalence of pressure ulcers has remained constant at about 7% over the past 20 years, even though considerable time and money have been invested in various prevention strategies– Whitfield MD, Kaltenthaler EC, Akehurst RL,

Walters SJ, Paisley S. How effective are prevention strategies in reducing the prevalence of pressure ulcers? J Wound Care. 2000;9:261-266

What Do We Know?

• 1.3 million to 3 million adults have a pressure ulcer.• Estimated cost to heal each ulcer is $500 to $40,000 • The incidence of pressure ulcers varies greatly by

clinical setting: 0.4% to 38.0% for hospitals, 2.2% to 23.9% for long-term care, and 0% to 17% for home care

• Pressure ulcers in elderly persons have also been associated with increased mortality rates– Lyder CH. Pressure ulcer prevention and management.

JAMA. 2003;289:223-226

Personal Story

• Have we normalized the occurrence of pressure ulcers, do we believe they are “just going to happen?”

Attitude and culture

Litigation• Patient safety concerns were triggered

following the release of the Institute of Medicine's 1999 report "To Err is Human: Building a Safer Health System."

• A recent Congressional investigation demonstrated that nearly 9,000 citations of abuse were issued over 2 years among the nation's 17,000 nursing homes starting in 1999. Among the abuses identified were "untreated bedsores.“

Litigation• The Attorney's Quick Guide: "The 6

Essential Elements of Pressure Ulcers You Must Find in the Medical Record.“– What every attorney in pressure ulcer litigation must find in the

medical record of the acute and long-term care settings, including:• The six elements of a pressure ulcer assessment that must be documented by the nurse• The seven common areas for pressure ulcers to develop• A common documenting gap that kills the defense• 4 Questions that must be asked about infected wounds• What is eschar and how it can delay pressure ulcer healing

– http://www.hgexperts.com/article.asp?id=5020

Financial– As of October 1, 2008, the Center for

Medicare and Medicaid Services (CMS) no longer pays for the cost of care for a facility-acquired pressure ulcer

– HealthGrades, Inc. recently reported that 445,028 pressure ulcers developed in almost 14 million Medicare patients (32 cases/1,000 patients) from 2005 to 2007 and cost $2.41 billion in excess healthcare costs

2009 Annual Report: MN Adverse Events Report

Pressure Ulcer Hospital Data*

*National prevalence study performed 2 days in 2008 and 2009- reported as percent of patients that developed a stage 2, 3 or 4 PU while in hospital.

MN is in this

group

Per

cent

%

Call to Action

• “What do our residents/patients expect from us?”– No harm, no pressure ulcers– “You can save my life but cannot prevent a

pressure ulcer?”– Working together with a focus on continuous

improvement– Wanting those that provide their care to be the

best, not just “good enough”

Flow of Day• Learn from our content expert about the standard

of care and a comprehensive approach to maintain skin integrity

• Work together to identify solutions to common barriers

• Work together to begin or continue planning our actions and changes

Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities.