The announcement in which it all started
Last year, the Medicare and Medicaid Services Centers announced that in October 2008, it would stop compensating hospitals for treating eight preventable diseases, including pressure ulcers. This simple statement has put hospitals across America in alarm and for good reason. Until now, most hospitals have focused on treating ulcers under pressure and severe pain and life-threatening infections, rather than their prevention.
This is understandable, since the number of hospital patients who develop pressure ulcers has increased by 63% over the past 10 years and almost 60,000 deaths annually from hospital ulcers.
But this is not the only fee. According to the Agency for Research and Quality of Health, the average stay for patients admitted to hospital for the treatment of hospital ulcers was 13 days, with an average cost of $ 37,500 per stay.
Without hospitals, you can afford to just continue treating ulcers when they occur without Medicare, to subsidize your expenses, something needs to be done. Diseases under pressure may initially develop when the patient’s blood supply stops for more than two to three hours or is aggravated by constant pressure on the skin and tissues.
When a patient is immobile or has difficulty moving after surgery or procedures, even the slightest burns of friction created by sheets, wheelchairs or other surfaces can quickly turn into an ulcer under pressure. One of the problems is that ulcers under pressure are initially difficult to identify, sometimes looking no more than a pink or red spot on hard-to-reach areas such as skin folds or bony protrusions.
And when they occur, complications, such as skin, blood and skin infections, can develop rapidly. It is not only patients who suffer; but just like hospitals, the treatment of ulcers in childbirth often costs more financially and in human hours than the measures that could precede them. It does not even take into account the cost of judicial hospitals and care facilities that may be encountered in order to put their patients at risk of developing ulcers.
So what can we do? We must use proactive medication, turning our main protocols for sore throats under pressure into ulcer prevention programs.
I know what you say. Your institution already has a program to identify patients who are at risk for developing an ulcer. You may even have a wound management specialist for treating patients and instruct your staff on proper procedures. But as hospitals across the country have seen, if pressure ulcers still occur, there may be no answer to the main protocols.
For example, Tibodu Regional Medical Center in Louisiana already had a higher than average ulcer. But when their data on quality improvement revealed an increase in the frequency of ulcers at the end of 2003, they decided to launch the Six Sigma project to solve these problems. After reviewing the data, they were surprised by the exit. At first they determined that the tools they used to analyze their care were unreliable. Secondly, some of the preventive measures that rely, for example, on using a particular type of patient bed, did not have such a positive effect on patient outcomes as small improvements.
For example, the way to perform smaller tasks is squatting. The recommended changes that came out of the project included simple shifts in the procedure, including the reorganization of wound care products at nursing units and the creation of task lists for CNA.
Additional solutions:
- Posting a turn schedule in patient rooms to determine if it is necessary and document the results of a patient's Q2H turn
- Heads of units to solve skin problems during annual competency testing
- Reports on patient's skin problems when changes change
Result? A decrease in the level of ulcers in nosocomial pressure by sixty percent with an annual cost reduction of about 300,000 US dollars. The best way to create and implement a new FMD prevention program is to model successful programs created by other hospitals and to recreate this success in your own enterprise.
That is why our organization has created a database of information about ulcers, causes, treatment, successful prevention programs, six sigma projects, and even other products and patients. This is a great place to start.
So how is your object evaluated? Is it possible to improve the frequency of your patient's ulcer? Now is the best time to find out. With a little analysis, research and a lot of planning and implementation, you will be ready and able to provide your patients with the best skin care. And this is what good medicine is about!
