Pressure is On to Reduce Pressure Ulcers

Cheryl Clark, for HealthLeaders Media , November 21, 2013

But the financial penalties aren't the reason for increased efforts, she says.

Rather, it was "public reporting of these conditions that really got our attention. It's not like we didn't know we had them, but we didn't have rates we could compare with other hospitals. And ours was a pretty high rate."

The hospital already had a wound care nurse who was part time but decided to increase that to full time, and gave the nursing support staff additional education so they have wound care certification. Sonora's expanded efforts include working with Premier healthcare alliance's Hospital Engagement Network and looking at where its patients were getting pressure ulcers, such as around the ear due to oxygen tubing friction.

And it turned out that a lot of the ulcers occurring were associated with nasal cannulas used to deliver oxygen. Leaders realized that they could purchase different products that reduced the risk, such as a cannula that had a padded part that fit over the ear.

Elastic stockings, special cold pads, and skin inspections of patients every 12 hours or at the start of every shift change were also implemented, "so we can catch problems early and implement these tools to keep any redness from developing into a pressure ulcer," Hukari says.

Sonora has also given more attention to patient nutrition, to beef up calories and the amount of protein to speed wound healing.

At 382-bed WellStar Cobb Hospital in Austell, Ga., the two-year preventable pressure ulcer rate for the period that ended June 30, 2011, was 0.239, higher than the national average of 0.136 per 1,000 eligible discharges.

Marcia Delk, MD, WellStar Cobb's senior vice president for safety, quality, and credentialing and chief quality officer, says that failure to document patients who came in with pressure ulcers was one reason the hospital might have looked worse than it was.

"Previously, nurses would recognize a pressure ulcer and start interventions, but they didn't document it. It took a little time for the team to understand what those needs were and make sure they reflected [them] in the record."

Other practices include the use of what Delk calls a "turn and assist" product to protect the sacrum, a common site of pressure ulcers. The product is made from parachute-like material that reduces friction and slipping, absorbs moisture, and helps staff reposition patients.

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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.




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