Collaborative Tracks 70 Percent Reduction in Pressure Sores

PRINCETON, N.J.–After nearly two years of applying best
practices and preventive techniques, 150 hospitals, nursing homes
and home care agencies in New Jersey tracked a 70 percent reduction
in the incidence of new pressure ulcers in their patients.

Ranging from redness and irritation to extensive destruction of
tissue, muscle and bone, pressure ulcers, commonly known as bed
sores, affect more than 1 million patients annually. Costs
associated with their treatment exceed $1.3 billion, according to
the New Jersey Hospital Association.

More important, the association said, “the human toll of pain,
depression, altered self-image, infection and increased mortality
is immeasurable.”

Of the organizations taking part in the NJHA’s Pressure Ulcer
Collaborative, 48 reported achieving results of no new pressure
ulcers for a period of three months or more. In addition, data
showed that the prevalence of existing pressure ulcers as patients
moved from one care setting to another was reduced by 30
percent.

Data was tracked from September 2005 through May 2007.

Improvement techniques used by staff across care settings
included:

–a complete skin evaluation within eight hours of
admission;
–an evaluation of the risk of skin breakdown;
–implementation of preventive strategies, such as proper
positioning and use of assistive devices; and
–ongoing observation of the condition of patients’ skin,
particularly for those identified as being at high risk for
developing a pressure ulcer.

As part of the bundle of interventions for home patients, “once
an individual was identified as being at risk for development of
pressure ulcers, we wanted [the care provider] to strive for
implementation of some kind of preventive intervention within 24
hours of that risk being identified,” said Theresa Edelstein,
NJHA’s vice president of continuing care services.

The organizations taking part in the project were given a review
of various positioning and support surface devices to help
“understand the principles behind each of those different types of
devices and how they are utilized with different patient
populations, such as critical care and hospice,” Edelstein said. No
specific type or brand was recommended, she added, but educating
the organizations about the preventive devices led many “to take a
look at their protocols and how they are making use of these
devices with a better understanding of what they are meant to
do.”

As a result, Edelstein said, some of the home care agencies
involved “documented a significant reduction in rehospitalization
rates related to wound infection and wound care in general. The
agencies have seen that they made a difference, and that’s a very
exciting and positive result for them and for their patients.”

A second phase of the project is being planned, Edelstein said,
because there are many different facets of dealing with pressure
ulcers, and not all of them are avoidable. The sores could be
nutrition-related, medication-related or dressing-related, “and all
of those things intertwine,” she said.

“We want to know what is the best way to get the best results
for those patients who develop a pressure ulcer in spite of our
best efforts.”