Prevention of pressure ulcer

Abstract

The number of hospital patients who develop pressure sores has risen by 63 % over the last 10 years, and nearly 60,000 deaths occur annually from hospital-acquired pressure ulcers. It has been estimated that it costs between 1.5 and 5.0 billion dollars a year to manage pressure ulcers in the United States [1]. In the United States in October of 2008, the Centers for Medicare and Medicaid Services announced that it will stop reimbursing hospitals for treating reasonably preventable conditions—pressure ulcers are among these conditions. That announcement has put hospitals into a state of anxiety, and with good reason, up until now, the majority of hospitals focus on the treatment of pressure ulcers, rather than preventing them. Section 5001(c) of the DRA required the Secretary to identify, by October 1, 2007, at least two conditions for which hospitals under the IPPS (Inpatient Prospective Payment System) would not receive additional payment beginning on October 1, 2008, if the condition was not present on admission. The conditions (a) must be of high cost or high volume or both, (b) must result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. For discharges occurring on or after October 1, 2008, hospitals would not receive additional payment for cases in which one of the selected HACs was not present on admission. That is, the case would be paid as though the secondary diagnosis was not present. Pressure ulcers are one of the hospital-acquired complications that CMS deems to be preventable, and as a result, prevention is on the forefront of all hospital policies. Pressure ulcers can affect any patient that has limited mobility due to illness or disease. There are some patient populations that are at greater risk than others. Individuals with spinal cord injuries have a high incidence of pressure ulcer development. It has been estimated that 25 % of individuals will develop a pressure ulcer in a year, with 85 % having at least one pressure ulcer in his/her lifetime [1]. Individuals aging with spinal cord injuries will have increased risk as age-related changes affect the strength and elasticity of the skin. Niazi et al. found that the recurrence rate for patients with spinal cord injuries who develop pressure ulcers was 35 % [1]. The treatment of pressure ulcers is approximately 25 % of the cost of caring for individuals with spinal cord injury. The cost of prevention is approximately 10 % the cost of treatment [1, 2]. Another population at greater risk for pressure ulcer development is the elderly especially those in long-term care facilities. Twenty-five to thirty-five percent of elderly patients in these facilities develop pressure ulcers during their length of stay. Prevention is the key to improving these patients’ quality of life and reduces the burden that pressure ulcers place on our healthcare systems.