Pressure ulcers cause pain, disfigurement, and infection and often require months to heal. Many patients commonly cared for by hospitalists (elderly, malnourished, and immobile) are at risk. Traditionally, pressure ulcers have been viewed as a low priority by physicians and are often considered a nursing issue. Since October 1, 2008, when the Center for Medicare and Medicaid Studies classified in‐hospital development of stages 3 and 4 pressure ulcers as a “never event”, treatment of these ulcers has not been reimbursed. In response to this mandate, our urban, academic medical center created an interdisciplinary team to develop a systemwide approach to prevention.
To bring attention to the issue throughout the hospital, we measured the prevalence of all pressures ulcers (especially stages 3 and 4) and provided tools for staff members to reduce occurrence in at‐risk patients.
To accurately determine the number of hospitalized patients with pressure ulcers, prevalence days were set up on a quarterly basis. On these days every patient in the hospital underwent a total skin exam by an expert skin care team. Our multidisciplinary team used the data to diagnose the current state of affairs of pressures ulcers and then put forth the following interventions. (1) Two nurses on each unit underwent an extensive training program created by the quality improvement team. This education focused on ulcer prevention, staging, and treatment. (2) A skin‐care reference manual was created and placed on each inpatient unit so that treating physicians and nurses would have easy access to pertinent ulcer diagnosis and treatment information. (3) Electronic medical record documentation was simplified and clarified for physicians through programming that allowed for easy transfer of nurses' ulcer documentation into the physician note. (4) Educational sessions on pressure ulcer prevention, treatment, and staging were held with hospitalists, internal medicine residents, surgery departments, and intensive care unit staff. (5) The pressure ulcer quality improvement team collaborated with the falls prevention team in the development of a safer patient‐centered model of care.
After implementing this program, we realized an observable decrease in total ulcer prevalence, from approximately 13.7% in March 2008 to 7.8% in September 2008. Prevention of pressure ulcers is critically important for patient safety. The frequency of stages 3 and 4 ulcers is also being used as an indication of quality of care provided in hospitals. Combined with new financial incentives, hospitals need reproducible methods to prevent stages 3 and 4 ulcers in hospitalized patients. Our hospital wide program for prevention, diagnosis, and accurate treatment utilized a multidisciplinary approach, including physicians, nursing staff, hospital administration, and collaboration with the IT department. Further efforts will attempt to lower the prevalence of pressure ulcers and sustain results.
C. Perumalswami, none; C. Ritter, none; J. Garrett, none; K. Goetz, none.
To cite this abstract:Perumalswami C, Ritter C, Garrett J, Goetz K. Pressure Ulcer Prevention and Treatment Strategies at Northwestern Memorial Hospital. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 128. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/pressure-ulcer-prevention-and-treatment-strategies-at-northwestern-memorial-hospital/. Accessed April 3, 2020.