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The effects of pressure ulcers can be both painful and very costly. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear, heat and Rochelle Froloff, RN and OR Nurse Consultant for Action Products, Inc.humidity. Pressure ulcers can occur as a result of several contributing factors.

According to Mary Montague, Manager of the Wound Care Consult Team at the Cleveland Clinic, pressure ulcers can carry a heavy burden for not just patients, but medical facilities, too. “Pressure ulcers (preferred to the outdated term bed sore), most often occur from unrelieved pressure. Comorbid conditions, malnutrition, and certain medications, are among other contributing factors,” Montague says. “An acquired pressure affects a patient’s quality of life, extends length of stay, and contributes to hospital readmissions, along with morbidity and mortality.”

Pressure ulcers can be very harmful to patients, negatively impacting recovery and causing frequent pain, which could lead to the onset of serious infections. The effects of pressure ulcers can lead to a longer hospital stay, sepsis and even death. According to the Pressure Ulcer Advisory Board, nearly 60,000 U.S. hospital patients are estimated to die each year from complications resulting from pressure ulcers.

On average, the cost of managing one full-thickness pressure ulcer can cost nearly $70,000. In the U.S., the total cost for treating pressure ulcers is estimated at $11 billion annually. There’s no doubt, pressure ulcer prevention is extremely important in medical facilities, however, it continues to be a reoccurring problem. Rochelle Froloff, RN and OR Nurse Consultant for Action Products, Inc. says heavy workloads in the OR contribute to problems in patient handling. “Often there is too large of a patient load for the nurses or PCN, so guidelines of turning the patient are minimized,” Froloff says. “For the facility, infections from open wounds acquired in a hospital are not being reimbursed. This lack of reimbursement has a huge effect on the bottom line.”

“The cost of treating a hospital acquired pressure ulcer imposes a significant financial burden on health care facilities, since The Centers for Medicare and Medicaid Services, as well as many private insurance payers have ceased reimbursement for these conditions,” Montague says. Froloff outlined several key mistakes hospitals make in patient handling practices, which lead to pressure ulcers and how proper patient handling can prevent them from occurring:

  1. Not being consistent in product use.
  2. Assuming that pressure management products should only be reserved for the sickest patients or longest procedures
  3. Have protocols in place for proper positioning and pressure management.
  4. Have consistent education and product in-servicing.

With the pressure ulcer problem growing and costs rising, many facilities are looking into more efficient ways to prevent and treat pressure ulcers. Froloff says healthcare organizations can take these steps to reduce pressure ulcers:

  1. Institutions should re-evaluate their staffing parameters to ensure that there are adequate personnel to care for patients on different units.
  2. Skin assessments should be done frequently to catch ulcers before they progress.
  3. Product selection to prevent decubitus ulcers should be tested and validated.
  4. Pressure management protocols need to satisfy all factors that contribute to pressure ulcers (pressure, shear, heat and humidity) in order to be effective.

Montague says pressure ulcers are considered reasonably preventable, so prevention has become a priority across all inpatient settings. “As a fundamental of value-based care, evidence-based pressure ulcer prevention programs help institutions offset reimbursement penalties,” Montague says. “Regular skin assessments, frequent repositioning with the use of offloading devices, optimization of nutrition, use of skin barrier creams, and the use of appropriate bed and chair surfaces, all assist in the prevention of pressure ulcers.”

Unfortunately, Froloff does not see the frequency of pressure ulcers declining in the future. Froloff has spent several years advising hospitals throughout the world on positioning and pressure ulcer management and assists medical facilities in maintaining their zero tolerance goals. “I see this as a problem that will continue to grow as our population is getting older and experiencing more problems that contribute to pressure ulcers like diabetes, obesity, cardiovascular disease, and nutritional deficiencies,” Froloff says.

Looking ahead, hospitals may decide to invest more into better patient handling practices to reduce and, hopefully, eliminate pressure ulcers. “The prevention of pressure ulcers through the use of evidence-based pressure ulcer prevention programs is less costly than treating a pressure ulcer,” Montague says. “An acquired pressure ulcer not only affects reimbursement, but is also a publically reportable condition.”

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