Pressure Ulcer Prevention
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EXPERIMENT WITH NEW PRACTICE PATTERNS
Why the dismal failure rate? We can think of two possible reasons:
- Nursing home staff are unaware of the importance of PU risk reassessments, and/or
- Insufficient numbers of licensed nurses make it difficult to complete reassessments.
The first impediment is being tackled right now. You for one now know better.
The staffing problem is considerably more difficult to resolve, and as such, demands an institutional willingness to experiment with new practice patterns. Ask yourself this: Would you rather devote staff time to PU prevention or PU treatment? Indications are that the more you do of the first, the less you'll do of the second-and vice versa. For all the reasons cited at the start of this section, we recommend devoting adequate staff time to delivering preventive care.
Institute a Triage System
If you agree, consider implementing the "triage system" presented on the following two pages. Be aware that this system has not been tested in a rigorous research trial--not yet anyways. It is based on professional opinion and expertise, driven by the best available evidence. At its heart is an understanding born of experience and research that many nursing homes, given current staffing ratios and reimbursement levels, simply cannot deliver all that we ask of them (though most can come closer than they do). Failure to acknowledge this may fuel widespread deception, as evidenced by the fact that nursing home workers often record care that they never deliver (10, 11). This in turn can lead to poor clinical decision-making, for it discourages the use of objective targeting assessments, which strive to make abundantly clear who needs what (and may not be getting it).
Our triage system stands in contrast to the usual care practices in many nursing facilities. It makes concerted use of objective assessment data so that can you improve clinical decision-making and at the same time shape a care process that is actually feasible to implement.
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