toolkit for pressure ulcer prevention and treatment - Oklahoma ...

SOSSAVE OKLAHOMA’S SKI NA Systems Approach to Quality Improvement in Health CareToolkit for Pressure UlcerPrevention and TreatmentOklahoma Foundation for Medical Qualityimproving health care Improving Lives

SOSSAVE OKLAHOMA’S SKI NA Systems Approach to Quality Improvement in Health Care:Toolkit for Pressure Ulcer Prevention and Treatment(Revision Date June 2009)IntroductionTable of ContentsPressure Ulcers OverviewSection 1Organizational Commitment and Policies for PressureUlcer Prevention and TreatmentSection 2Screening, Assessing and Monitoring Pressure UlcersSection 3Prevention and Treatment of Pressure UlcersSection 4Care Planning for Pressure UlcersSection 5Staff, Family and Patient/Resident EducationSection 6Transitions of CareAppendicesA Glossary of Pressure Ulcer TermsBPressure Ulcer GuidelinesCResourcesThis material was prepared by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for Oklahoma, under contract with theCenters for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily representCMS policy. 962-PU-856-0409Pressure Ulcer Prevention and Treatment (Rev 06/09)Page 2

OverviewPressure Ulcers: OverviewA pressure ulcer is localized injury to the skin and/orunderlying tissue usually over a bony prominence, asa result of pressure, or pressure in combination withshear and/or friction. A number of contributing orconfounding factors are associated with pressure ulcers.(National Pressure Ulcer Advisory Panel (NPUAP),2007) The NPUAP developed a universal staging systemfor pressure ulcers based on the depth and type of tissuedamage. This staging system is commonly used forassessment and care planning.The ProblemPressure ulcers have been documented as a significantproblem across the lifespan and across all health caresettings, as well as a significant source of pain and humansuffering. The elderly may be at greater risk to developpressure ulcers due to the changes in the skin related toaging as well as the many co-morbidity factors present inthis population (Knox, et. al., 1994). Billions of dollarsare spent annually (Reddy, 2006) on the prevention andtreatment of pressure ulcers, with the cost of treating onepressure ulcer ranging from $2000 to $30,000 and ashigh as $70,000. (Young, 2003)Pressure ulcers are among the most common conditionsencountered in patients who are acutely hospitalized orrequire long-term institutional care. Critically ill patientsadmitted to intensive care units are at particularly highrisk of developing pressure ulcers (de Latt, et. al., 2007).Two and a half million people in the U.S. develop apressure ulcer in the acute care setting (IHI, 2007) andapproximately 60,000 people die every year as a resultof complications from pressure ulcers. (Nursing Center,2007)In addition, pressure ulcers have been used as an indicatorof quality of care and their development has constitutedgrounds for litigation.The Centers for Medicare & Medicaid Services (CMS)has long focused on helping nursing homes preventpressure ulcers, and in 2008, they extended this effortacross health care settings. CMS recently increasedSOSSAVE OKLAHOMA’S SKI Nattention on multiple clinical topics, including theoccurrence of pressure ulcers when patients move fromone health care setting to another.CMS data from 2007 to 2008 shows that overall,seven percent of Oklahoma’s nursing home residentsdeveloped a pressure ulcer. During this same time period,Oklahoma had the third highest rate of pressure ulcers forhigh-risk residents in the nation.Oklahoma had the thirdhighest rate of pressureulcers for high-riskresidents in the nation.Hospitalizations involving patients with pressure ulcers—either developed before or after admission—increasedby nearly 80 percent between 1993 and 2006. Amonghospitalizations involving pressure ulcers as a primarydiagnosis, about 1 in 25 admissions ended in death. Thedeath rate was higher when pressure ulcers were a secondarydiagnosis—about 1 in 8. Pressure ulcer-relatedhospitalizations are longer and more expensive than manyother hospitalizations. While the overall average hospitalstay is 5 days and costs about $10,000, the average pressureulcer-related stay extends to between 13 and 14 daysand costs between $16,755 and $20,430, depending onmedical circumstances. (AHRQ 2008)While the incidence of pressure ulcer occurrence inhospitals has not been previously reported, as of October,2008, CMS required hospitals to begin collecting andreporting this data. Additionally, CMS has provideda financial incentive to hospitals to prevent thedevelopment of pressure ulcers.Diligent efforts of care givers can reduce pressure to bodyareas, however, there are some inherent characteristics(e.g., co-morbidities, high-risk diagnoses, immobility)that cannot be removed, changed or modified.Occasionally, these additional factors can make thedevelopment of certain pressure ulcers unavoidable.This material was prepared by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for Oklahoma, under contract with theCenters for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily representCMS policy. 962-PU-856-0409Pressure Ulcer Prevention and Treatment (Rev 06/09)Page 4