Pressure ulcers are a common complication for hospitalized patients, residents of nursing homes and long-term care facilities. It is a significant cause of disability, suffering, and degradation of quality of life for patients. Therefore, I thought it would be a good topic for my first diary for Kosability. I did a search on DK and came up with a few items, the most notable of which was this diary, on how to pick a care facility for a loved one. Very nice article, and great resource. I plan to use it to help patients and their families make a choice that is good for their loved ones.
BTW, thank you for the invitation to write for Kosability. I am honored by the opportunity.
More than just a Pain on the Butt (Patient Stories)
In medicine we use a concept called POEMs (Patient Oriented Evidence that Matters). The idea is to review medical literature, and rate studies based on their clinical relevance, validity, and reported outcomes, with attention on what makes the most difference for patients. In that vein, I thought to begin this diary by talking about what pressure ulcers (or as the new terminology calls them - pressure injuries) mean to patients and their experiences of health and illness, how it affects their lives, and the lives of those who care for them. I would appreciate it if readers could please share their own stories of suffering from pressure ulcers, or of taking care of someone who suffered from them, in the comments, and I will add them here as updates. Thank you in advance.
Journal of advanced nursing; 11/2006 Volume: 56 Issue: 4 Page: 345-353 PMID: 17042814
This paper reports the findings of a pilot study exploring the experience of older people living with pressure ulcers. In this study a group of patients were interviewed about their experiences of having pressure injuries, and their responses were gathered and analyzed. Three main themes and corresponding subthemes emerged (content below distilled from the paper and paraphrased by me).
Theme |
Sub-theme |
Endless pain |
Constant presence |
|
Keeping still |
|
Equipment pain |
|
Treatment pain |
Restricted life |
Impact on self |
|
Impact on others |
|
Consequences |
Coping with a pressure ulcer |
Comparison |
|
Acceptance |
Endless pain
Constant presence
The first theme was that of endless pain. Pain was described as a constant presence and “enough to make ‘a grown man cry’”. This is something that obviously creates a great amount of suffering for patients. It also creates a big challenge for physicians, because in today’s climate of pain medicine overuse, overdoses from opiates, and greater scrutiny on over-prescribing of opiates, it is hard to maintain a balance between minimizing patients’ suffering and preventing improper use of pain medications. If readers have any thoughts on this, please share in the comment section. I look forward to reading your experiences and comments on this, and we can discuss it together.
Patients in this study commented that any kind of movement by them or by caretakers increased their pain and suffering.
“I don't dare move because everything then gets worse. I lie very still.”
“I don't move it. As soon as I do it'll jump and start all over again.”
"… holes in both sides of my bottom … I could not move in bed or nothing. It was ever so sore.”
When healthcare providers select treatment modalities, it is important to consider patients’ points of view. Patients in this study used graphic descriptors to depict the alternating pressure mattresses, describing the mattress cells as ‘lumps’ or ‘rods’, sticking into their backs or aggravating their pain. One patient said, ‘As it comes up, the pressure is on the sore, you really do feel it’.
Even the wound treatment was found to improve or worsen the pain. For some, the decrease in pain at dressing change meant that they were getting better. For others, the pain was ever‐present even though the wound showed evidence of healing. “When they clean it, it is like a needle scraping my nails. It is very painful”.
Restricted Life
For many patients the event of a pressure ulcer was shocking. We are not used to thinking ourselves as being disabled. “It is a wound and I am not used to it.”
Suddenly becoming disabled makes a person internalize their illness. Patients often compare themselves negatively to how they were before they got sick, and negative thoughts start to wear away on their spirits. “Miserable sod I was. I would not speak to no one. I would not let them touch me or nothing”.
Thus there was great awareness that these restrictions in turn had a significant impact on others. Primarily, the participants were anxious about their spouses, sibling(s) or children and the inherent burden that their restrictions put on them, causing the family additional worry.
Treatment for pressure ulcers led to extended hospital stays, and created restrictions placed on rehabilitation, delaying patients’ return to normal life. Patient who had nurses visit their homes for continued care reported that the nurses’ visit restricted participants’ lives and reduced their ability to remain involved in their social activities. “Although the nurses are very good and try and come at a certain time, the whole of my morning is completely disrupted until they are gone, then I have the rest of the day to myself”.
Coping with a pressure ulcer
The participants knew that they were not the only ones with pressure ulcers, “I am not alone in that”.
Several participants also commented that, despite the pain from the wound, this was not the worst health experience they had had: “Those are problems. The wound is nothing in comparison.”
“It would be worse if my tongue stopped working!”
These comparisons often led participants to an acceptance of their situation with an air of fatalism through their discussion: “With me, I say what will be will be” or “Well, that's how it is, I suppose – the pain in the heel, you put up with it”. Acceptance also went hand in hand with trying to play their part: “They help me and I have got to try and help them” or “I know I have to be careful”.
Talking about it did not change the situation, but positive thinking was necessary to help them through. “You are very conscious of it when it is hurting and you think you have worked through an ulcerated area before, so you just try and get on with your normal life”. Several people tended to underplay the enormity of the impact of the pressure ulcer.
KosAbility reader stories:
carolita
What an excellent diary! Thank you so much. I am currently in the eighth month of treatment for pressure injury and it isn’t going very well, but this is a lot of food for thought. In the hospital I went through all of the types of mattresses and I found them all to be uniformly hideous — causing more pain than they could ever prevent.
Apparently my particular situation resulted in quite a bit of damage before it was noticeable. I now have shear-related injuries about the size of an outstretched hand on the backs of both legs, which makes it nearly impossible to use my electric scooter. As a result, I am becoming far less active, which is very bad for my overall health. I can really relate to your discussion of pain and the resulting desire to not move as much as possible. Even lying down is painful.
Right now I’m using A&D and foam bandages, which has been the most successful treatment to date. I live at home with my husband, but I do have home healthcare. However, I have a deep suspicion that my doctor doesn’t know (or care) much about this condition, so I am trying to learn as much as I can about it and you have certainly given me a lot of places to go for research. I really appreciate it.
2
In 1975, Dr. J. D. Shea developed a staging system for the classification of pressure injuries.
In 1989, the NPUAP developed a pressure injury staging system, using a consensus conference model; this taxonomy was based on the International Association of Enterostomal Therapy system.
In 1992, the first version of the Clinical Practice Guidelines for Pressure Ulcers was put together by the National Pressure Ulcer Advisory Panel (NPUAP) and released by the Agency for Health Policy and Research (AHCPR) now known as Agency for Healthcare Research & Quality. This resource became widely known as “The Purple Book” and was the first reliable compendium of pressure ulcer prevention and treatment. Current AHRQ resources on pressure ulcers.
In 2007, the NPUAP revised their staging system to incorporate suspected Deep Tissue Injury (sDTI) again using the consensus conference model.
In 2009, the first NPUAP-EPUAP International Pressure Ulcer Prevention and Treatment Guidelines further revised the staging system for international use by adding the term category/stage, which is frequently used outside the United States.
In 2014, NPUAP Introduced New Clinical Practice Guideline for Pressure Ulcers.
In 2015, the American College of Physicians (ACP) released a clinical practice guideline for the treatment of pressure ulcers. (see below)
In 2016, NPUAP revised staging criteria and terminology of pressure ulcers (now called injuries instead of ulcers). Roman numerals were changed to Arabic numerals in the names of the different stages. This change was made to clarify and reduce the potential for confusion between similar terms used in health care such as a Stage IV and intravenous (IV).
In 2016, WCON released Guideline for Prevention and Management of Pressure Injuries (Ulcers). (see below)
Definition
The 2016 NPUAP Pressure Injury Staging System uses the term injury instead of ulcer. There are several reasons for this change. Histopathological work indicates that small changes in pressure-related injuries start in the tissue prior to the changes being visible on physical examination. An ulcer cannot be present without an injury, but an injury can be present without an ulcer. An ulcer is defined as a break in skin or mucous membrane with loss of surface tissue, disintegration and necrosis of epithelial tissue, and often, purulent exudate (pus). An injury is defined as bodily damage caused by transfer of energy, and also the absence of energy (cold).
source of below images: www.ncbi.nlm.nih.gov/…
Staging
The NPUAP Pressure Injury Staging System identifies 4 stages for pressure injuries, based on the depth of the injury. There is also a non-stagable type, where necrotic tissue within the view obscures the view for assessing the depth of the injury. Deep-tissue pressure injuries are those which are existing below the skin surface, but cannot be seen from the outside.
Non-pressure injuries have different staging systems. Only pressure injuries should be staged with the NPUAP Pressure Injury Staging System. Non–pressure-related ulcers and wounds should use their own appropriate staging system: diabetic foot ulcers (Wagner Classification System), venous leg ulcers, skin tears (International Skin Tear Advisory Panel), adhesive or tape injuries (Medical Adhesive Related Skin Injury categories, MARSI) , burn classification (total body surface area).
The graphics below provide details about the definition and criteria for diagnosis of each stage. To get a larger view of each image, right click and select view-image, then use control/command with + to enlarge the images.
WARNING Some of the images below may be bothersome to some readers. Viewer discretion is advised. If you want to skip them, scroll down to the “Epidemiology” section. If you’re eager to get to the “what to do” sections, scroll down to “Risk Factors”.
If you would prefer to skip the technical stuff and jump to the practical & coping part, skip down to Risk Factors.
The information for the following sections, up until General Care, have been obtained from Uptodate.com, and distilled and paraphrased by me.
Epidemiology
An estimated 2.5 million pressure-induced injuries are treated each year in acute care facilities in the United States.
Patients admitted to nursing homes present with pressure injuries at reported rates on admission ranging from 10 to 35 percent. Residents of long-term nursing homes usually have lower rates (3 to 12 percent). Studies show that 4 to 8 percent of nursing home residents develop stage 2 or deeper pressure injuries after six months. On the other hand, if residents were regularly examined, incident rates could be as high as 24 percent, with prevalence rates of over 70 percent among high-risk patients. (the more you look, the more you will find?)
In nursing homes that fostered a culture of resident-centered care, patients did not have worsening rates of developing pressure ulcers. This study was done in the VA system’s Community Living Centers (CLCs). They have an interesting point about the balance between the relationship of residents and staff which can lead to better care, versus resident autonomy which may lead to poor decisions on the part of the resident, which may lead to worse outcomes. So one may conclude that residents/patients should sometimes relinquish their autonomy and trust what the caretakers advise them to do… ?
It has been theorized that the changes in care processes and resident autonomy associated with nursing home culture change may affect pressure ulcer prevention. The mechanism for this has been identified as the strength of the complementary nature between quality of life and quality of care. If a facility's adoption of culture change, for example, results in better and closer relationships between nursing home residents and staff, staff should be more able to work with residents to implement effective pressure ulcer prevention measures, but implementation of culture change that promotes resident quality of life through greater resident autonomy may result in residents making decisions, such as lying only on one side to face a window or remaining seated to watch television, that ultimately increase the likelihood of pressure ulcer development. onlinelibrary.wiley.com/...
Pathophysiology
Pressure injuries have traditionally been thought to develop as a result of a combination of factors, including pressure (force per unit area), friction, shearing forces (gravity effect on friction), and moisture, and other contributing factors.
If the pressure on the skin exceeds the pressure inside small feeding blood vessels (32 mmHg), flow of blood to the skin and underlying tissue is reduced, and hypoxic damage (from lack of oxygen supply), accumulation of metabolic waste products, and free radical generation (chemicals that can form in the body and are very reactive, and can cause damage to tissues) occur. If pressure exceeds 70 mmHg for two hours, irreversible tissue damage has been shown to occur in animal models. If even higher pressures are sustained, they can cause rapid ulcer formation, within one to four hours.
Different tissue types vary in their susceptibility to pressure-induced injury. Muscle is the most susceptible, followed by subcutaneous fat and skin. Therefore, deep tissue damage can occur prior to any evidence of damage is observed on the skin surface. An extensive deep pressure injury may develop, and rapidly progress to the surface as a high-stage pressure injury, without a step-wise progression from stage 1 through stage 4.
Tissues that overlie bony prominences experience the greatest pressures. Pressure can be applied by contact with any external object, including mattress, machinery, devices, IV lines, catheters, etc. A patient lying on a standard hospital mattress may experience pressures of 150 mmHg. Heavier patients will experience greater pressures. While seated, tissue over the ischial tuberosities (bones in the groin that we sit on) can experience pressures as high as 300 mmHg.
Tissue overlying a bony prominence experiences a cone-shaped distribution of pressure, with larger mass of affected tissues located deep, adjacent to the bone-muscle interface. As a result, the extent of injury to deep tissues is often much greater than what can be seen from the visible ulcer on the skin surface, and the skin changes are just the "tip of the iceberg". The original article by Shea in 1975 demonstrated this idea.
Reperfusion injury also plays an important role. This is when tissue that has been damaged due to lack of blood flow and oxygen supply, suddenly experiences a restoration of blood flow, and the sudden increase of oxygen supply leads to generation of oxygen radicals, which further damage the tissue.
When patients are placed on an inclined surface such as a bed with raised head, their bodies experience shearing forces. The skin and underlying subcutaneous layers remain fixed in contact with the bed surface, but deep tissues including muscle and fat layers are pulled down by gravity. The separation of and stretching of tissue layers causes trauma to the tissues, blood vessels, and lymphatic channels. This damage adds to the damage caused by pressure and worsens the overall injury.
Friction occurs when patients are dragged on any surface. The resulting frictional forces can cause an abrasion and damage to the superficial layers of skin. Friction most commonly contributes to formation of stage 2 pressure injuries, and not so much to stage 3 or stage 4 injuries, since it does not cause the necrosis of deep tissues that are a hallmark of stage 3 or stage 4 injuries.
Other types of skin injuries, including maceration and tears, tape burns, perineal dermatitis, or excoriation should not be labeled as pressure injuries. It is also important to make a distinction between pressure injuries, and superficial lesions which are primarily the result of moisture, and perhaps should not even be considered pressure injuries. Exposure to moisture as a result of perspiration, feces, or urine may lead to skin maceration, and predispose the skin to superficial ulceration. However, there is little evidence to help determine the magnitude of the contribution of moisture to the development of skin injury.
Immobility — Immobility is the most important risk factor that contributes to development of pressure-induced skin and soft tissue injury. Immobility may be permanent or transient.
Malnutrition is also a risk factor for the development of pressure-induced skin and soft tissue injuries.
Reduced skin perfusion – With decreased circulatory perfusion of skin due to comorbid conditions, pressure applied to the skin for less than two hours may be enough to cause severe damage. If vital organs such as the kidneys and the gastrointestinal tract are not adequately perfused, blood flow to the skin will be shunted towards the internal organs, and that will increase the risk for the development of pressure-induced injuries.
Sensory loss — Neurologic diseases such as dementia, delirium, spinal cord injury, and neuropathy are important risk factors for the development of pressure-induced skin and soft tissue injuries. Sensory loss among these patients is common, suggesting that patients may not perceive pain or discomfort arising from prolonged pressure. Other contributors are immobility, spasticity, and contractures, which are common in these conditions.
Risk Assessment
This is a health tool based on the Norton risk-assessment scale scoring system which was published in 1962 as the first mean of evaluating pressure ulcers risk. Commonly used today in the clinical and nursing sectors, it was initially intended to be used within the geriatric hospital population. The Norton score for pressure ulcer risk calculator comprises of five parameters, relevant to skin condition, which are applied, each with different answer choices which weigh a different number of points:
The Braden Scale for Predicting Pressure Ulcer Risk, is a tool that was developed in 1987 by Barbara Braden and Nancy Bergstrom. The purpose of the scale is to help health professionals, especially nurses, assess a patient's risk of developing a pressure ulcer.
Complications
Pressure-induced skin and soft tissue injuries can serve as a reservoir for resistant organisms such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multiply resistant gram-negative bacilli, and colonized or infected ulcers pose a potential risk to other hospitalized patients.
Other complications may include:
●Sinus tracts that communicate with the deep viscera, including the bowel or bladder (the wound forming tunnels that can injure/penetrate other body structures)
●Occasional heterotrophic calcification (abnormal accumulation/deposition of calcium in damaged tissue)
●Systemic amyloidosis (accumulation of protein deposits in different parts of the body, such as the heart) due to the chronic inflammatory state arising from the ulcer.
●Squamous cell carcinoma (a type of skin cancer). This can develop in a chronic wound and should always be considered in those with a non-healing wound.
General Care
The American College of Physicians (ACP) developed guidelines to present the evidence and provide clinical recommendations based on the comparative effectiveness of treatments of pressure ulcers. Interventions evaluated included different support surfaces, dressings, medications, and adjunct therapies. This guideline is based on published literature on this topic that was identified by using MEDLINE, EMBASE, CINAHL, EBM Reviews, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and the Health Technology Assessment database through February 2014.
They looked at a select list of commonly used treatment interventions.
They looked at how these interventions compared with other interventions or placebo, as reported in the studies that they reviewed. This table shows the results of their review.
To see a larger version of the table below, right click on it and select view image, then use control/command with the + key to enlarge it.
When different interventions were compared against each other or against placebo, many interventions were found to be no different than the comparing intervention. Thus in the end, the ACP recommendations are limited to three interventions which were found to be supported by existing evidence.
ACP recommends that clinicians use protein or amino acid supplementation in patients with pressure ulcers to reduce wound size.
ACP recommends that clinicians use hydrocolloid or foam dressings in patients with pressure ulcers to reduce wound size.
ACP recommends that clinicians use electrical stimulation as adjunctive therapy in patients with pressure ulcers to accelerate wound healing.
Another set of recommendations have been provided by WOCN. Founded in 1968, the Wound, Ostomy and Continence Nurses Society (WOCN) is a professional, international nursing society of more than 5,000 health care professionals who are experts in the care of patients with wound, ostomy and incontinence.
Recommendations from the updated 2016 Guideline for Prevention and Management of Pressure Ulcers (Injuries) from the Wound, Ostomy and Continence Nurses Society (WOCN)
Journal of Wound, Ostomy and Continence Nursing Issue: Volume 44(3), May/June 2017, p 241–246
This is a condensed summary of their recommendations.
Perform risk assessment early and frequently, especially in patients who are immobile. Use a valid risk assessment tool and consider the known risk factors. Consider factors internal and external to the patient. Differentiate between pressure injuries and skin damage caused by moisture from urine, stool, and perspiration. Implement an individualized plan for management of incontinence. Assess patient’s nutritional status upon admission and regularly for any changes. Consider the impact of the pressure ulcer on the patient's quality of life. Assess healing using valid tools, and regularly evaluate for complications.
Minimize/eliminate pressure, friction, and shear to help prevent pressure injuries. Minimize/eliminate pressure from medical devices such as oxygen tubing, catheters, cervical collars, casts, and restraints. Keep head of bed below 30 degrees or at lowest angle needed for patient’s condition. Schedule regular repositioning and turning for bed-bound and chair-bound individuals. Use dressings to prevent sacral and heel ulcers. Use heel suspension devices. Use pressure redistribution devices as adjuncts to careful repositioning strategies. http://algorithm.wocn.org Avoid foam rings, foam cut-outs, or donut-type devices for pressure redistribution, because they actually focus pressure onto small areas, and can lead to pressure injuries. Use skin barrier creams to keep skin dry. Provide adequate nutritional support.
Use heal flotation strategies, and turn and reposition the patient, regularly and frequently. Cleanse the wound and surrounding area while minimizing damage to surrounding tissue. Provide adequate caloric and protein nutritional support. Choose appropriate solutions for cleaning pressure ulcers, which may include tap water, cooled boiled water, saline. Assess biofilm and bacterial load, use topical antibiotics, antiseptics, or systemic antibiotics as required. Consider surgical intervention when needed. Modify type of dressing used to help heal and prevent further pressure ulcers. Take measures to eliminate or control pressure ulcer pain. Implement measures for ulcer healing, recognizing that complete healing may be unrealistic in some patients. Educate patients and families about prevention and treatment of pressure ulcers.
Assessing Recovery
As pressure injuries are treated and heal, various scales can be used to assess and monitor that recovery. The pressure injury stages described above are only to be used for assessing the stages of the injury, and not to track backwards in the recovery of the injury (you don’t go from a stage 4 injury to stage 3). The recovery stages monitor changes in surface area, extent of necrotic (dead) tissue and exudate (pus), and the presence of granulation tissue (tissue generated by the body for wound recovery). Some of these tools are the Pressure Sore Status Tool (PSST), the Sessing Scale, the Wound Healing Scale, and the Pressure Ulcer Scale for Healing (PUSH) tool. The PUSH tool has been clinically validated, and is easy to use.
Costs
There are many options for treating pressure injuries, and as noted above, some have been found to be effective, and some not so much. But how much cost is associated with them, and are insurance companies or whoever pays for them, able or willing to do so? I found this study interesting, because it evaluated the clinical efficacy versus the cost effectiveness of a few interventions.
Preventing Pressure Ulcers in Long-term Care: A Cost-effectiveness Analysis
Arch Intern Med. 2011;171(20):1839-1847. doi:10.1001/archinternmed.2011.473
jamanetwork.com/...
This study assessed the cost effectiveness of four different interventions for pressure ulcers. [They] used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care.
Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs [Quality Adjusted Life Years] and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2).
It seems that strategy 2 and 3 take a lot of resources to implement, and benefit fewer patients than the other two strategies (higher number-needed-to-treat). Pressure redistribution mattresses are clinically effective and cost-effective. Nutritional supplementation is clinically important, but harder to justify based on cost. Skin emollients are cost effective and clinically helpful. Foam cleansing instead of washing with soap and water is more effective, but can be expensive.
Racial/Ethnic disparities
Like with everything else in medicine, racial and ethnic disparities exist in the treatment and outcomes of pressure ulcers. This study looked at those disparities among nursing home patients.
Racial and Ethnic Disparities in the Healing of Pressure Ulcers Present at Nursing Home Admission
(public access)
The results of this study showed a significant unexplained disparity for the Blacks: the observed pressure ulcer healing in the Blacks was significantly worse than what would be expected based on the clinical and care characteristics of the Blacks. For example, the sample of Blacks had more Stage 4 pressure ulcers at admission than the Whites, but even after taking this into account, the Blacks had worse outcomes than expected.
…
Recommendations for health care organizations to reduce racial-ethnic disparities in care are multi-pronged (Chin et al., 2012; King et al., 2008; Smith, 2002). These recommendations include collecting racial and ethnic information of care recipients so disparities in care can be monitored (Smith, 2002) and communicating the achievement of benchmarks in more equitable care within the organization as well as externally to the community around the NH (Chin et al., 2012; King et al., 2008; Smith, 2002). Our findings suggest that healing of pressure ulcers and not only their development be monitored by race and ethnicity and included in such communication. Implementing a system-wide disparity reduction process that includes a targeted response to specific disparities, such as in pressure ulcer healing, which has the support from leadership at all levels of the organization is another possible strategy. Other recommended practices include providing incentives and rewards to individuals within the organization for progress in reducing disparities and training staff about culturally competent care (Chin et al., 2012; King et al., 2008; Smith, 2002). For NH care, having a more racially and ethnically diverse nursing workforce that is competent in implementing cross-cultural approaches to care has been proposed to aide in reducing health disparities (Gonzalez, Gooden, & Porter, 2000). The U.S. Affordable Care Act is expected to have a positive impact on the health of minority populations over time by providing greater access to health insurance and reducing financial barriers to care (Errickson et al., 2011). Greater healthcare access designed by laws such as this one (Errickson et al., 2011) could decrease the number of older minority individuals who are admitted with pressure ulcers to NHs or result in less severe pressure ulcers.
BOOM! Single Payer! (bold and underline above by me)
Healthcare Policy
As mentioned above (BOOM!) Medicare for All will ensure that all patients suffering from pressure injuries will get the proper care, without having to worry about payments, without having to fight with insurance companies, and without being discriminated against based on race, ethnicity, and ability to pay.
The nurse’s organization WOCN, recently submitted comments to CMS regarding payments for pressure injuries. Click on the link provided for more information regarding their advocacy activities.
CMS recently requested comments on a pending quality measure dealing with pressure injury management in the acute care setting. The measure entitled "Hospital Harm - Hypoglycemia; Hospital Harm - Hospital-Acquired Pressure Injury" deals with developing an electronic clinical quality measure for hospitals to account for hospital-acquired pressure injury.
The Society has been hearing from members who are concerned with how providers and hospitals are being penalized by the outcomes of current quality measure on pressure injuries despite providing quality care. The current measures to not adequately capture and track pressure injuries are resulting in both reduced data collection and quality of care. The Society's comments in their entirety on these measures can be found
here. In addition to the official written comments the Society submitted, the Society is planning an additional face-to-face meeting with CMS staff to express our concerns in hopes that we can work with regulators to develop more adequate measures to track pressure injuries.
Thank you for reading. I hope the information provided will help patients and families to partner with their physicians and nurses, to assess, prevent, and treat pressure injuries. I look forward to reading your personal stories and comments/feedback.
I hope you don’t mind if I shamelessly plug a couple of my other diaries:
#MailMedicalBillstoCongress
We can’t keep sitting around waiting for Congress to fix our broken healthcare system, while we suffer from the stress and consequences of backbreaking medical bills and poor health caused by non-surance companies refusing to pay for our medical care. Please take all your medical bills every month, and write with a big red marker on them “PASS SINGLE PAYER”, and mail them to your Representative and Senator.
Beyond Healthcare Reform: A Social Transformation for Health Through the Lifetime
In order to have a healthy society, with lower healthcare costs in the future, we need to start with our youngest members, from age 0-3 years. But there are many things we can do to keep our older citizens healthy too, by providing universal healthcare for one thing, paid parental leave, food security, and public transportation only as starters. Press your congresscritters to make these things happen!
Thank you!