Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - News on Dr. Levine's medical and consulting practice, and reflections on our healthcare system.

Category: Risk Management

Pressure Ulcer as “Never Event”: Fact or Myth?

The term “never event” is commonly applied to pressure ulcers, giving the impression that they are always associated with medical error. As such, it lends this outcome an emotional charge that can lead to misplaced patient dissatisfaction and unnecessary accusations of wrongdoing or poor quality. Although pressure ulcers are sometimes associated with factors such as inadequate staffing and nutritional care, the preventability of all pressure …Read More

New Research Suggests Hypotension is a Risk Factor for Pressure Ulcers

The industry-wide acceptance of risk assessment scales for pressure ulcers has gotten us accustomed to evaluating risk factors for skin breakdown. The most popular is the Braden Scale which incorporates subscales of sensory perception, moisture, activity, mobility, nutrition, and friction and shear. There are however, other factors which add to pressure ulcer risk which need to be taken into consideration. According to research recently published in the …Read More

New Research Challenges “Q2H” Turning Standard for Pressure Ulcer Prevention

The industry standard for turning and repositioning a patient at risk for pressure ulcers is every two hours. There is, however, limited research to support this standard. As the costliest elements of pressure ulcer prevention are support surfaces and repositioning, a change in this standard would have major economic impact. A research study published in the October 2013 issue of the Journal of the American …Read More

The Unavoidable Pressure Ulcer Gains Credibility with Geriatrics Practitioners

The 8th Edition of the Geriatric Review Syllabus (GRS8) released this year contains a brief but significant addition to the chapter on pressure ulcers: a section on the unavoidable pressure ulcer. This is the first time an official study guide for the medical specialty of geriatrics acknowledges that pressure ulcers can occur in the regular course of care delivery. The GRS is published by the …Read More

CMS recognizes the Kennedy Terminal Ulcer in Long-Term Care Hospitals

The Kennedy Terminal Ulcer (KTU) has been around for over two decades, and continues to play a large part in discussions as to whether pressure ulcers are avoidable or unavoidable. Until now the Center for Medicare and Medicaid Services (CMS) has not acknowledged the KTU in its regulatory and reimbursement guidelines for hospitals and nursing homes. In a new transmittal from CMS, the KTU can …Read More

Pressure Ulcer Nomenclature and Documentation

Flawed and inconsistent wound documentation has serious risk-management implications.  This blog post will examine some fine points regarding pressure ulcer nomenclature and documentation. Many definitions and classification schemes for pressure ulcers were developed over the years and continue to be a source of confusion.  As patients move across the healthcare continuum from hospital to rehabilitation facility to nursing home, descriptive data can vary greatly even if …Read More

Government Study Cites Flawed Medical Device Approval Process

FACT: Many wound-care products are considered “medical devices” with limited data on efficacy. A new study released by the Institute of Medicine points out that the FDA’s approval process for medical devices is flawed.  Medical devices include high profile items such as hip replacements, but this class of products also contains many items on the market to treat chronic wounds.  The New York Times noted that even …Read More

Healthcare Reform Provision Helps Lawsuits Against Nursing Homes

A little known provision of President Obama’s Healthcare Reform Act is designed to help plaintiffs and their attorneys bring legal action against nursing homes for alleged neglect and abuse.  With the demographic transformation of America toward an aging society, lawsuits against nursing homes have surged.  In response some privately owned nursing homes have developed complex corporate structures that obscure who controls the facilities, making it difficult for attorneys …Read More

CMS Tightens Up Pressure Ulcer Classification in Long-term Care

Revised Minimum Data Set (MDS) 3.0 Section M: Skin Conditions greatly expands the process of skin assessment in nursing homes.  The accompanying Resident Assessment Instrument (RAI) Instruction Manual has instructions on how to identify and code pressure ulcers and other wounds using a methodology that is explicitly stated.  These instructions include the following: “If an ulcer arises from a combination of factors which are primarily …Read More

Determining the Avoidability of Pressure Ulcers

One of the biggest challenges in caring for patients with pressure ulcers from a risk-management  standpoint is determining whether the ulcer was avoidable.  The National Pressure Ulcer Advisory Panel has recently come out with a statement that “Not all pressure ulcers are avoidable.”  As a reference point, we can look at the Interpretive Guidelines for F-Tag 314 issued by the Department of Health & Human …Read More