Can nurses do more for patients coming from ECFs with stage III pressure ulcers?

Libby1987 · Jan 15, 2017

In the U.S., is reimbursement tiered in ECFs/SNFs? To pay for increased staffing?

I'm thinking not as in my experience requests to place total care patients are much tougher than those with higher levels of functioning.

foggnm · Jan 15, 2017

You are going to burn yourself out worrying about fixing all the problems in other facilities. While in a 'perfect world' all immobile patients in a nursing home would have special beds/devices/care that kept their skin perfect, it isn't the case in reality. Unfortunately immobility creates endless opportunities for medical problems (and not just skin issues). If you really have a passion for preventing this problem, then maybe work as a manager or quality coordinator in long term care. Your leadership could certainly be used there. But if you're the hospital nurse, the care a patient receives at another facility is out of your control.

allnurses Guide · Jan 16, 2017

We see it time and time again. Patient is admitted from an ECF with a stage III sacral ulcer, and likely additional ulcers on the heel.
What can nurses do to advocate for these patients aside from just caring for them in the hospital and sending them back to be neglected?

Well I worked long term care and we frequently got patients from the acute setting with hospital acquired pressure ulcers. That's because Medicare one and ulcer develops so the are shipped out to LTC for treatment which Medicare will pay for. Honestly I believe that PU's develop about equally in acute and long term settings. The key is prevention which involves way more that turning q 2 hours.

Also not all PUs are cause by neglect! There's way too many factors to go into here but I spent a lot of time with the wound care doc when I was treatment nurse at an LTC.

Hppy

djh123 · Jan 16, 2017

Amen to some of y'all talking about how crazy it is (re: patient & staff ratios) in LTC facilities. In mine, we have few people who develop bad pressure ulcers, but yet another factor is that sometimes the patient really, really, does not want to sit/lie in bed in any position but one. Yeah, we have to try to use wedges, pillows, get them up as much as possible for meals, etc., but sometimes it's still difficult to do as much preventative care as you'd like due to patient resistance (and/or sometimes the occasional aide who isn't doing that they should).

kbrn2002, ADN, RN · Jan 16, 2017

Sigh, yet another post blaming the LTC facility. Granted not all LTC's provide stellar care, but not all hospitals do either. I don't think it matters what the care setting is some places are great and others, well not so much. Not to mention that there are instances when that pressure ulcer is just about unavoidable due to a variety of reasons such as patient noncompliance and natural disease process.

Case in point is Christopher Reeves. This was a relatively young man with the money and means to acquire the best care possible and yet he still developed a pressure ulcer, it was pretty widely reported at this time of death that complications related to this contributed to his death.

Another case in point that I have first hand knowledge of is an elderly gentleman in my SNF. He is known to be noncompliant and suffers from dementia along with his multiple physical ailments. His noncompliance with cares involves striking and kicking at staff. He was hospitalized a few days. While we don't ever restrain a resident in our SNF the local hospital has no such restrictions and this gentleman had his feet and hands restrained during cares. When he returned he had a pressure ulcer on his heel that subsequently required surgical debridement and multiple rounds of ABX. Amazingly, with the good care we were able to provide this hospital acquired pressure ulcer eventually healed. It took months, but heal it we did.

So rant over. I guess my point is that not all pressure ulcers can or should be blamed on a LTC facility. They can develop at home, in assisted living settings, in an acute care hospital and yes, in a LTC. No matter the living arrangements the root cause of a pressure ulcer is not always a matter of poor care.

djh123 · Jan 16, 2017

Sigh, yet another post blaming the LTC facility. Granted not all LTC's provide stellar care, but not all hospitals do either. I don't think it matters what the care setting is some places are great and others, well not so much. Not to mention that there are instances when that pressure ulcer is just about unavoidable due to a variety of reasons such as patient noncompliance and natural disease process.
Case in point is Christopher Reeves. This was a relatively young man with the money and means to acquire the best care possible and yet he still developed a pressure ulcer, it was pretty widely reported at this time of death that complications related to this contributed to his death.
Another case in point that I have first hand knowledge of is an elderly gentleman in my SNF. He is known to be noncompliant and suffers from dementia along with his multiple physical ailments. His noncompliance with cares involves striking and kicking at staff. He was hospitalized a few days. While we don't ever restrain a resident in our SNF the local hospital has no such restrictions and this gentleman had his feet and hands restrained during cares. When he returned he had a pressure ulcer on his heel that subsequently required surgical debridement and multiple rounds of ABX. Amazingly, with the good care we were able to provide this hospital acquired pressure ulcer eventually healed. It took months, but heal it we did.
So rant over. I guess my point is that not all pressure ulcers can or should be blamed on a LTC facility. They can develop at home, in assisted living settings, in an acute care hospital and yes, in a LTC. No matter the living arrangements the root cause of a pressure ulcer is not always a matter of poor care.

Yes. And not to blame hospitals either, because as you say, there is good and bad care in all types of facilities, but in my LTC facility, I'm not exaggerating when I say that the worst pressure ulcers I've seen or have been aware about were people who came FROM the hospital, not the other way around.

CoffeeRTC, BSN, RN · Jan 17, 2017

Sigh, yet another post blaming the LTC facility. Granted not all LTC's provide stellar care, but not all hospitals do either. I don't think it matters what the care setting is some places are great and others, well not so much. Not to mention that there are instances when that pressure ulcer is just about unavoidable due to a variety of reasons such as patient noncompliance and natural disease process.
Case in point is Christopher Reeves. This was a relatively young man with the money and means to acquire the best care possible and yet he still developed a pressure ulcer, it was pretty widely reported at this time of death that complications related to this contributed to his death.
Another case in point that I have first hand knowledge of is an elderly gentleman in my SNF. He is known to be noncompliant and suffers from dementia along with his multiple physical ailments. His noncompliance with cares involves striking and kicking at staff. He was hospitalized a few days. While we don't ever restrain a resident in our SNF the local hospital has no such restrictions and this gentleman had his feet and hands restrained during cares. When he returned he had a pressure ulcer on his heel that subsequently required surgical debridement and multiple rounds of ABX. Amazingly, with the good care we were able to provide this hospital acquired pressure ulcer eventually healed. It took months, but heal it we did.
So rant over. I guess my point is that not all pressure ulcers can or should be blamed on a LTC facility. They can develop at home, in assisted living settings, in an acute care hospital and yes, in a LTC. No matter the living arrangements the root cause of a pressure ulcer is not always a matter of poor care.

I can't agree more!!!

One thing to note, is that if the discharge planners at the hospital get wind of a high pressure ulcer rate or falls or some other indicator of poor care at a facility..they can push admits somewhere else. I live in a very competitive area. There are many choices for LTC in our area.