Pressure Ulcer Prevention
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FAILURE TO TARGET SERVICES CAN CREATE EXTRA WORK
Findings from our evaluation of PU care in 16 nursing homes (2) suggest that facilities may be creating extra work for themselves. In this study, we examined PU care for 329 residents whose most recent Minimum Data Set (MDS) assessment had triggered the PU resident assessment protocol (RAP). This RAP is initiated if a resident presents with one or more of seven PU conditions:
- limited bed mobility
- bed-fastness
- bowel incontinence
- peripheral vascular disease
- a stage 1-4 PU
- history of PU in the last 90 days
- use of a trunk restraint daily
Of our 329 PU risk residents, 90% had documented orders that they be repositioned every two hours as a preventive measure. That's nearly everyone! Even the best staffed nursing homes would struggle to manage this workload.
Routine repositioning, a costly intervention because it is so labor intensive, is recommended in best practice guidelines for PU risk residents who are (and here's the key phrase) bedfast or who are unable or have limited ability to reposition themselves (3).
Had nursing home staff followed these guidelines, only 64% of the participating residents would have been targeted for repositioning; that's the percentage assessed in their MDS as bedfast or immobile in bed. But wait: even this percentage may be too high.
In a related study, we found that nursing home staff tend to overestimate residents' dependency levels for bed mobility. We compared nursing home staff MDS bed mobility ratings to our performance assessment ratings for 197 residents in 26 nursing homes (4). Of the 60 residents we rated as "able to move," 37, or 62%, were rated by nursing home staff as requiring physical assistance to move. That's 37 residents who may have been getting staff help they didn't need and possibly didn't want.
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