Optimizing a Hospital System to Prevent Pressure Ulcers

According to the Centers for Medicare and Medicaid Services (CMS), pressure ulcers are among the most common, expensive, and avoidable hospital-acquired complications.  Pressure ulcer prevention needs to be embedded within the day-to-day workflow of the healthcare system.  To cope with the burden of pressure ulcer prevention, hospitals need to incorporate risk assessment and prevention techniques into daily care of patients. This blog post is based on an article I wrote with my colleague, Sarah Lebovits RN, MSN, APRN-BC, CWOCN, an outstanding wound-care nurse I worked with at St. Vincent’s Hospital who is now at New York University Medical Center.  It was originally presented at the World Union for Wound Healing Societies in Toronto, June 2008, and covers all the items a hospital needs to address to prevent pressure ulcers. 

Dr. Jeff Levine specializes in geriatric medicine

1. Assess policies and procedures relevant to wound documentation, risk assessment tools, prevention techniques, and skin assessment along with ease of understanding, thoroughness, accuracy of terms, and incorporation of current evidence-based information.

2. Ensure documentation systems require thorough data on skin condition on admission assessment, transfer screening, and discharge planning. Electronic records should automatically calculate risk assessment and flag prevention protocols.

3. Evaluate pressure ulcer risk daily in addition to on admission, transfer, and deterioration of condition. Results should be incorporated into daily documentation of critical care units.

4. Continually re-evaluate applicable policies and procedures when skin integrity is compromised.

5. Educate all staff on all shifts on prevention, skin assessment, staging, products, and documentation. All staff need to recognize deviations from the norm and front line caregivers additionally need to know where, how, and when to examine (eg, patient positioning, use of flashlights, palpation for induration, and local temperature). Continuous staff education and demonstration of competency for both nurses and primary care providers should be required.

6. Establish documentation standards, including photographs, for wound assessment.

7. Include inventory of product types, quality of products used, evidence-based efficacy, appropriateness, and cost effectiveness in any product evaluation. Support surfaces should be reviewed for age, condition, warrantee and service contract, and appropriateness for refurbishing or replacement. Managed care reimbursement is a consideration when assessing continuity of products on discharge or transfer.

8. Foster continuity of care — unit-to-unit within the facility as well as inpatient to outpatient. Patient discharge and transfer documentation should include skin condition as well as medications, treatments, and advance directives. Referral networks should include consideration of equipment and follow-up with appropriate agencies and/or clinicians.

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Dr. Jeffrey M. Levine has authored numerous articles on topics related to healthcare of the elderly. These include medical history, prevention and treatment of chronic wounds such as pressure ulcers, elder neglect and abuse, and physical restraints. He has also edited a book on legal and regulatory aspects of nursing homes.