Pressure Ulcers as a Quality Indicator?

[luffle]

I am writing a paper on pressure ulcers because think that they are expensive and difficult to treat. Pressure ulcers also decrease the quality of life for patients and increase mortality, especially in the elderly. I was wondering if anyone's unit uses pressure ulcers as a quality indicator. If it does, do you know what is the rate of pressure ulcers on your unit? Does your facility utilize a multidisciplinary wound care team or does the wound care team comprise of only nurses?

Thanks for your help.

[BeckyESRN]

I can't speak to rates, because I don't work inpatient any more. But when I did, our wound care team consisted of the head resident and their advisor (they pretty much just reviewed orders), a wound care nurse (she has 25+ years in wound care) and 2 nurses that would round with her for skin assessments. We would enter a wound care consult on any patient with a current wound or patients that we felt were at an increased risk. Wound care would evaluate and advise (consults, dietary, special precautions, special equipment-lambs wool booties, positioning aides, ect). All patients were ordered a PT eval, charting an increased risk would generate a dietary consult, the RN could order a specialty mattress as needed. We also had an outpatient wound care clinic staffed by that same team, plus other nurses and a surgeon.

[KeepinitrealCCRN]

i also don't know much about exact rates but we do not have a lot of pressure ulcers that are acquired on our unit. we also have a wound care nurse who rounds every day and she will see every pt that they have a wound consult on. we will also alert her to other patients that we need more clarification on who may not have a consult an she is happy to see them. pressure ulcers can definitely be a quality indicator depending on the unit but keep in mind ICU vs. nursing home is very different. some patients in the ICU are too unstable to turn and they are usually on vasopressors which really complicates things and is not a reflection on quality so much. also, I'm assuming in nursing homes(never worked in a nursing home or LTC) the staffing is awful so they may not be able to provide the care needed when so short staffed. all that being said it just depends on the specifics on the unit and patient and is not always a quality issue.

[amoLucia]

Am reading this late, but in LTC the occurrence of pressure ulcers is SUPER CLOSELY monitored for statistical reports that the DOH checks when doing its surveys.

Besides the reasons OP gives, the in-house development of pressure ulcers is to be AVOIDED UPON PAIN OF DEATH TO LTC STAFF (serious stuff if one occurs). That's because I believe that the facility has to absorb the cost of treating the ulcers because of the regs that govern reimbursement by CMS. Major financial burden for the facility!!

I'm fuzzy on all this as I wasn't directly involved with the monitoring, treatment & reports, etc. That usually fell to the DON or ADON (or other designee) or a Wound Team. As UM, I do remember completing a form for survey that counted wounds. As supervisor, I would often be responsible that care plans were updated for interventions for ANY residents identified at risk. And I know that MDS monitors wounds also with quarterly wound risk assessments.

So I doubt that the average staff nurse has any in-depth knowledge of info OP seeks. Information from CMS may be the info you seek.

When survey occurs, the survey team usually would zoom in on a pressure ulcer pt and would like to see the wound for themselves and to assess wound care tx skills, like med pass, by staff. They would fine-tooth comb the med record for RD consult recommendations, pertinent lab work, physician involvement, PAIN MANAGEMENT, prescribed wound tx, out-pt wound care center consultation PRN, care plan interventions (BIG MONITORING), etc. Family involvement at quarterly care plan meetings also. I mean, we're talking that they scrutinize care. So it BEHOOVES all concerned disciplines to be on the top of their game.

Also, the pt admission (and readmission) assessment process is SUPER thorough to check for community-acquired (hospital or home) occurrences.

To SICUmurse - please know that while many NH/LTC facilities have serious staffing problems, it should NEVER EVER be acceptable to excuse lack of preventative and interventional pt care tasks, such as freq repositioning & turning, to staffing inadequacies. While not perfect, most places do try. I will concede that yes, there are poor facilities, but pressure ulcers as a quality indicator is a PRIORITY if they want to be paid (and stay open).