Pressure Ulcer Prevention
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"AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE"
Old as it is, this adage wisely sums up one of the major thrusts of efforts to improve pressure ulcer (PU) care in nursing homes. PU prevention can be done, and there are good reasons to do it:
- For starters, most of us would agree that PU prevention is in the best interests of nursing home residents. After all, the clinical consequences of developing a PU are serious: increased morbidity and mortality, increased risk of infection as well as pain, depression, and stress. This should be reason enough to strengthen PU prevention efforts, but if it's not, consider this:
- PU treatment is costly. A report by LUMETRA (1) cites evidence that PU treatment costs in nursing homes exceed $355 million a year, and that estimate was calculated in 1997. Since then healthcare costs have spiraled up.
- PU prevention is a better buy. Though by no means free, PU prevention can lower treatment costs while improving clinical outcomes (2). Finally…
- We've listed it fourth, but some nursing homes may consider it the number one reason to beef up PU prevention efforts: Inadequate PU prevention is one of the top two causes for malpractice litigation against nursing homes. A 1999 study found that adherence to PU prevention guidelines could have saved healthcare defendants $11,389,989 in 20 lawsuits (3).
Given these compelling reasons to practice excellent PU prevention, it's unfortunate that such care is less than optimal in most nursing homes and downright substandard in many. Inadequate staffing is the usual defense against this charge, and it has some merit, for indeed most nursing homes have too few workers to provide proper care of residents (4) and insufficient reimbursement to hire more. But our recent research also suggests that nursing homes can make better use of the staff they have--and improve care--by targeting their services more intelligently.
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