Incidents of pressure ulcers on the rise
According to a recent report from the Agency for Healthcare Research and Quality, pressure ulcers, or decubitus ulcers, are increasing. "In 2006, there were 503,300 hospital stays during which pressure ulcers were noted — a 78.9% increase from 2003 when there were about 281,300 hospital stays related to pressure ulcers," the report says. And adult hospital stays related to a diagnosis of pressure ulcers totaled $11 billion in 2006.
William Spector, PhD, agency researcher and author of the report, says "we've identified a very expensive group of people that have received care in the hospital, and they're expensive because they tend to stay longer than the typical stay." Such patients, inordinately disabled people, not only stay longer but are more often discharged to a long-term facility.
"I think what's happening is we have a health system that's not focusing well on preventing some key things... we're treating people, but we're not seeing a lot in terms of prevention," Spector says.
Early identification of at-risk patients is a crucial part in getting a handle on pressure ulcers. These patients could be those who:
- have become disabled;
- are not able to control their bodies well;
- have pneumonia, septicemia, or urinary tract infections;
- are incontinent;
- have a compromised nutritional system;
- have bony prominences;
- have gone through surgery and are required to be immobile.
"This is not something that one clinician can do on their own," Spector says. "It's going to take a team of clinicians working together to identify how to make the process changes, the reengineering of how people work together to get the information to the right person at the right time to understand the changing risks, to make the clinical referrals necessary to prevent pressure ulcers and infections from happening."
Most hospitals, he says, do not have a designated person responsible for pressure ulcer prevention or treatment. Identifying patients in advance is not always possible, but certain patients should be on the radar screen, and everyone needs to be assessed.
The standard for preventing pressure ulcers is turning the patient every two hours, but nursing homes, which see a lot of these patients, aren't always doing that, he says, noting that research is being done on whether even this strategy is the best technique.
As people live longer and become immobile or more at risk for falls, patients are more likely to be immune to infections. "It's always a tradeoff worrying about the person falling and worrying about the other risks if you try to restrict their mobility. It's tricky," Spector says. "There needs to be some sort of strategic approach by an organization so that you at least reduce the risks and catch the problems early. I've heard people say they don't have a pressure ulcer problem in their nursing home because they have a program to keep people up and moving all the time. That's going to work but others get to the point where they're so disabled they get to a point where they can't do that."
With the Centers for Medicare & Medicaid Services present on admission reimbursement methodology, hospitals know now that pressure ulcers will cost them. "So it's a matter of a commitment by the institution that they're going to be building a team that knows their responsibilities about preventing pressure ulcers. It's not going to be by luck because it won't happen," Spector says.
(You can view resources and tools in dealing with pressure ulcers at the Institute of Healthcare Improvement's web site: www.ihi.org/IHI/Programs/Campaign/PressureUlcers.htm.)
According to a recent report from the Agency for Healthcare Research and Quality, pressure ulcers, or decubitus ulcers, are increasing.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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