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
Attitude and culture
• Have we normalized the
occurrence of pressure ulcers, do
we believe they are “just going to
happen?”
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*
2008-2009
9
MN is in
this
group
8
Percent %
7
6
5
2008-2009
4
3
2
1
0
East North East South
Central
Central
Middle
Atlantic
Mountain
New
England
Pacific
South
Atlantic
West North West South
Central
Central
*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.
High Risk Pressure Ulcer QI Measure Rates by Month
12.00%
11.00%
10.00%
9.00%
8.00%
7.00%
All Stratis Health Participants (43)
6.00%
All Other Minnesota NHs (excludes the
43 Stratis Health Participants)
5.00%
4.00%
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.