Development and Implementation of a Hospital-Acquired Pressure Ulcer Incidence Tracking System and Algorithm

Abstract

Hospital-acquired pressure ulcers (HAPUs) are a national concern due to patient morbidity, treatment cost, and reimbursement issues. Stages III and IV pressure ulcers (PUs) that occur during hospitalization are among the conditions considered preventable by the Centers for Medicare and Medicaid Services (CMS). Harborview Medical Center (HMC), located in Seattle, WA, is a Level 1 trauma/burn center and safety net hospital serving diverse populations. HMC is committed to providing excellence in care including optimal skin care and PU prevention to people from all walks of life. At HMC a new system for monitoring daily PU incidence, completing monthly multidisciplinary intensive reviews on HAPUs, and application of an algorithm used to determine if HAPUs were avoidable was developed and implemented. This system has assisted HMC in addressing PU tracking, prevention, compliance with regulatory mandates and has improved skinrelated outcomes.

Negative pressure wound therapy versus healing by secondary intention in pressure ulcers

“…The total cost in United Kingdom is between 1.4 and 2.1 billion annually, 4 which is confirmed by a recent systematic review. 30 Unfortunately, despite the intensive research in this particular area, there are few RCTs in the literature yet.…”

“…3 Therefore, the management and therapeutic approach toward these often hospital-or facilityacquired problems remain critical aspects of long-term care. 4 Often, complexities exist structurally within these wounds including undermining, tunneling, and sinus tract formation along with exudate and necrotic tissue. 5 These serve as barriers to healing as they may host resident and occult sources of foreign bodies as well as unreachable nonviable material, both of which may promote ischemia, inflammatory responses, and an increased susceptibility to pathogenic invasion.…”

To make or buy patient safety solutions

“…The cost of adverse events to these hospitals is high, which may induce them to engage in patient safety innovations. For example, Harborview Medical Center (HMC), located in Seattle, Washington, is a Level 1 trauma/burn center and safety net hospital serving diverse populations (Zaratkiewicz et al, 2010). In reaction to CMS's never event regulations (in HMC's case, specifically for preventable pressure ulcers), HMC created its own software system and a nurse-led team for monitoring daily pressure ulcer incidences among its patients (Zaratkiewicz et al, 2010).…”

Endotracheal Tube Holders and the Prone Position: A Cause for Concern

“…Therapists should be cognizant of the potential for these types of facial ulcers (usually associated with mask ventilation), which have been identified by Medicare as avoidable complications. 6 Facial edema associated with the prone position clearly increases the risk of airway complications regardless of the method of tube fixation. Clinicians should be vigilant to maintain airway position and prevent skin breakdown.…”