9 Strategies for Preventing Pressure Ulcers

nursehelpingpatientinbed.300Pay-for-performance programs and value-based purchasing incentives, along with intensified public reporting practices, are changing the way hospitals nationwide are addressing certain healthcare-associated conditions including pressure ulcers. According to an article published in Health Leaders magazine, hospitals are no longer looking at severe bed sores as “normal complications” to be accepted as par for the course when faced with certain illnesses and extended hospital stays.

In the article, “Pressure is On to Reduce Pressure Ulcers,” healthcare leaders from Crouse Hospital (Syracuse, N.Y.), Adventist Sonora Regional Medical Center (Senora, Calif.) and WellStar Cobb Hospital (Austell, Ga.) discuss the steps their facilities are taking to transition from a reactive to a proactive approach to combating bed sores. Instead of waiting for wounds to develop and then trying to determine a treatment protocol, these hospitals are working hard to prevent pressure ulcers from ever developing in the first place.

With 0.67 pressure ulcers per 1,000 eligible discharges, Crouse Hospital actually had one of the highest pressure ulcer rates in the country but has seen drastic improvement since the implementation of  its interventions. Similarly, since the launch of Adventist Sonora’s PUP (Pressure Ulcer Prevention) campaign, this facility has not had a patient with a hospital-acquired stage 3 or stage 4 pressure ulcer since May 2011.

Doctors at Johns Hopkins Medical Center have implemented an Early Mobility Program designed to get patients in intensive care units up and moving as soon as possible. In addition to preventing bed sores, this program, which is even being utilized with patients on ventilators, has proven to help build muscle strength and reduce pulmonary complications.

The following strategies, which these hospitals have found beneficial in preventing pressure ulcers, were discussed in the article:

  1. Encourage front line staff to watch closely for the earliest signs of skin redness. Early detection — at stage 1 or stage 2 — is key.
  2. Increase the number of wound care nurses and provide more education and training to nursing support staff.
  3. Perform daily skin assessments and intensify attention given to high risk patients. For example, establish a team of wound ostomy nurses charged with evaluating  patients who might be at higher risk due to lessened mobility.
  4. Utilize moisture barriers on vulnerable areas of patient skin surfaces. Some hospitals are finding that a silicon-based foam dressing protects the skin well.
  5. Establish adequate turning schedules. 
  6. Invest in specially designed beds and mattresses. Beds can come equipped with mechanisms to relieve pressure on heels and elbows while special mattresses, pumped with air and water, can make shifting a patient’s weight much easier.
  7. Analyze event data to determine any trends in the location of wounds. You may be able to conclude that a certain type of equipment is rubbing sores on patients. If so, an equipment change may be in order.
  8. Improve documentation of sores. Your facility should not be blamed for conditions it did not cause. So,  make sure that wounds present on admission are coded accurately.
  9. Assess and monitor patient nutrition. Better nutrition speeds the healing process.

To download the Agency for Healthcare Research & Quality’s Toolkit for Preventing Pressure Ulcers in Hospitalsclick here.

 

5 Stories You Need But May Have Missed This Week

mednews-roundup-logo-300x122We know you’re busy, but we don’t want you to miss important healthcare quality and patient safety news. Below is a roundup of stories you may have missed but need to take a look at before calling it a week. (Sign up on the right if you’d like these news alerts delivered to you.)

  1. Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality
    The Centers for Medicare & Medicaid Services has announced its second round of penalties and bonuses to hospitals under its Value-Based Purchasing Program. Medicare reduced payment rates for 1,451 hospitals and increased rates for 1,231 based on 24 quality measures, including patient satisfaction surveys and for the first time, death rates
  2. Hospitals Try Yogurt to Prevent Infections in Patients 
    Holy Redeemer Hospital won an innovation award from the Hospital and Healthsystem Association of Pennsylvania for its efforts to combat a significant increase in Clostridium difficile cases with the use of yogurts containing probiotics. Read about their process, findings and the impact researchers believe probiotics could have on the prevention of life-threatening infections.
  3. The Productivity Gap: Protecting Your Revenue When ICD-10 Goes Live 
    Having watched more than 20 countries including Canada transition to ICD-10, there are several steps the United States can take to prepare for our own switch to the new code a year from now. Learn more about how healthcare leaders can prevent excessive productivity loss by effectively: measuring and projecting productivity, training coders and adjusting resources as needed to accommodate effects of the switch-over.
  4. Interdisciplinary Care Starts with Respect for Colleagues
    Nurses, physicians,pharmacists and other clinicians are all essential to delivering high value, high quality care. Consider this author’s argument that our current top-down hierarchy is flawed and needs to be grounded in a mutual respect for each others’ contributions.
  5. AHRQ Releases Infographic and Video on Multiple Chronic Conditions
    With Americans living longer lives, healthcare providers are being called upon to treat more patients than ever with Multiple Chronic Conditions. According to AHRQ, two-thirds of older Americans are living with at least two chronic physical or behavioral illnesses, and that number is on the rise along with the mounting costs associated with what has become a major public health issue.

 

 

 

 

AHRQ Releases Infographic and Video on Multiple Chronic Conditions

ahrqmcc-logo-300x157With Americans living longer lives, healthcare providers are being called upon to treat more patients than ever with Multiple Chronic Conditions (MCC). According to the Agency for Healthcare Research and Quality (AHRQ), two-thirds of older Americans are living with at least two chronic physical or behavioral illnesses, and that number is on the rise along with the mounting costs associated with what has become a major public health issue.  Treatment for people living with MCC currently accounts for an estimated 66 percent of the nation’s health care costs.

In response to a need for tools that can be used in educating stakeholders regarding this issue, AHRQ’s Multiple Chronic Conditions Research Network has released a new infographic  that  presents key information about why research and care for people with MCC is important.  The information depicted in the infographic was extracted from an analysis of 2010 Medical Expenditure Panel Survey (MEPS) data conducted by Abt Associates.

In addition, a new 2-minute video from AHRQ tells the story of “Mae,” a woman living with MCC. In the short animation, Multiple Chronic Conditions: A Day in the Life, we watch as Mae visits one health care provider after another, struggling not to become overwhelmed by the onslaught of instructions, treatments and prescriptions she receives along the way.

For more information about the AHRQ Multiple Chronic Conditions Research Network and its efforts to address MCC through evidence-based research, click here.

mcc_infographic

More Than 1400 Hospitals Penalized in Value-Based Purchasing Round 2

cmsThe Centers for Medicare & Medicaid Services (CMS) has announced its second round of penalties and bonuses to hospitals under its Value-Based Purchasing Program. Medicare reduced payment rates for 1,451 hospitals and increased rates for 1,231 based on 24 quality measures, including patient satisfaction surveys and for the first time, death ratesAccording to a Kaiser Health News article, the largest bonus given for FY 2014 was a 0.88 percent increase awarded to Arkansas Heart Hospital, a physician-owned facility representative of the type of hospital some healthcare executives claim have an unfair advantage in this program.

Hospitals in Maine, Massachusetts, Nebraska, New Hampshire, North Carolina, Utah and Wisconsin received the highest scores with at least 60 percent of the hospitals in these states earning higher payments. On the other hand, at least two-thirds of hospitals in 17 states including California, Connecticut, Nevada, New Mexico, New York, North Dakota, Washington and Wyoming experienced reimbursement reductions.

Many of this year’s “winners” received bonuses last year as well, and most hospitals that received reductions last year continued that trend for FY 2014. However, 300 hospitals or healthcare systems did manage to improve their scores. According to KHN, organizations that were previously penalized but were awarded bonuses this year included: Massachusetts General, Vanderbilt University Medical Center and Ronald Reagan UCLA Medical Center. Conversely, a disappointing 416 hospitals, which earned bonuses last year, received penalties this year.

Patrick Conway, M.D., chief medical officer at CMS and director of the Centers for Clinical Standards and Quality commented in a blog post announcing the scores that these numbers actually signal “good news.”   “The fact that not every higher performing hospital last year made the grade this year, and not every lower performing hospital last year will see payment decline this year, means that hospitals are adjusting to the new world of value-based payment,” Conway said.

To access the FY 2014 Value-based Incentive Payment Adjustment Factors, click here.

4 Stories You Need But May Have Missed This Week

mednews-roundup-logo-300x122We know you’re busy, but we don’t want you to miss important healthcare quality and patient safety news. Below is a roundup of stories you may have missed but need to take a look at before calling it a week. (Sign up on the right if you’d like these news alerts delivered to you.)

  1. Anatomy of a Readmissions Master Plan
    Memorial Hermann made a commitment 10 years ago to identify and close care continuum gaps that were fueling a staggering readmission rate within a largely uninsured population. Read what they did to improve communication across their system, encourage accountability and follow-through as well as strengthen its base of human and IT resources.
  2. 10 Things to Know About the Two-Midnight Rule
    For healthcare organizations trying to decipher implications of the new two-midnight rule issued by CMS, here are 10 points to keep in mind regarding issues including: inpatient vs. outpatient status, MACs, RACs and the importance of physician documentation.
  3. The Brutal View from Medicine’s Front Lines
    This Forbes contributor poses some big questions regarding the obstacles preventing real change across our healthcare system. How can we expect innovation when “revenue capture” remains high priority for providers who seem to be “locked in a deadly battle with payors”?
  4. How Do Hospitals Build a Culture of Quality?
    Professor, physician and healthcare blogger, Ashish Jha, MD,MPH, believes a facility-wide commitment to “getting better” is the primary trait that distinguishes hospitals that continually deliver excellent outcomes and patient experiences from those that do not. Read this patient safety leader’s latest commentary and access his blog, An Ounce of Evidence, here.

[STUDY] How Hospitals Are Using PDSA to Drive Improvement

PDSA250 A new study published in BMJ Quality & Safety offers an evaluation of  the ways that Plan–Do–Study–Act (PDSA) cycles are being used to drive quality improvement in hospitals. PDSA cycles are an essential part of the Model for Improvement, a simple but effective tool used to speed change and improvement.

Until now, little research has been done to evaluate and compare application of the commonly used method across different facilities. The study is beneficial because it offers a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework. Findings promote a better understanding of how to best use this powerful tool.

To read the study, Systemic review of the application of the plan-do-study-act method to improve quality in healthcare, and to get a better understanding of how to use this powerful tool, click here.

 

6 Stories You Need But May Have Missed This Week

mednews-roundup-logo-300x122We know you’re busy, but we don’t want you to miss important healthcare quality and patient safety news. Below is a roundup of stories you may have missed but need to take a look at before calling it a week. (Sign up on the right if you’d like these news alerts delivered to you.)

  1. ECRI: Top 10 Health Tech Dangers
    Alarm hazards top the ECRI Institute’s 2014 list of health IT dangers intended to draw attention to looming tech-related threats to patient safety. Find out what other 9 safety issues the organization has identified as high priority for the coming year.
  2. Surgeons’ Disrupted Sleep Not a Safety Factor
    Access a first-of-its-kind study, published this week in the JAMA, that examined outcomes in cases where physicians, who performed emergency surgeries during the midnight to 7 a.m. shift, went on to operate on previously schedule patients later the same day.
  3. 3 in 4 Patients Want E-mail Consultations with Doctors
    Discover ways that doctors’ offices are addressing privacy and reimbursement issues associated with a growing demand for e-mail consults with their physicians.
  4. NY Hospital Group Grades Report Cards
    Read ‘HANYS’ Report on Report Cards, which used a three-star rating system to score 10 government and private organization-issued report cards. This response comes in the wake of much criticism voiced by frustrated hospitals claiming that some organizations’ flawed grading processes are generating nothing but confusion for stakeholders.
  5. Avoiding Checklist Fatigue: Interview with Dr. Thomas Varghese
    Dr. Varghese discusses why developers of the Strong for Surgery initiative believe that negative surgical outcomes are often “predetermined and modifiable.” Learn what tips he gives for combating “checklist fatigue” during the process of engaging and training patients for surgery.
  6. Joint Commission Announces ‘Top Performers’
    The Joint Commission’s annual quality report is out, and one third of the hospitals eligible for evaluation earned “Top Performer” billing by showing that they have provided an evidence-based care practice at least 95 percent of the time for patients with specified conditions.