Sometimes, an innovative surgery is only the first step in saving a patient. The second might be something as basic as changing their mattress material or the way they sit, to prevent the formation of a life-threatening bedsore.
Bedsores – also known as pressure ulcers – are lesions caused by unrelieved pressure, often over a part of the body where the bone lies directly beneath the skin, such as in the heel, sacrum or head. What might look like a harmless bruise on the surface can indicate serious trouble beneath the skin. A lack of blood flow to the pressurized area results in dead skin tissue and can cause damage or infection to the underlying muscle and bone if left unattended.
About 2.5 million patients are treated for pressure ulcers in the United States every year, according to the Agency for Healthcare Research and Quality, and about 60,000 die as a direct result of the condition.
Nurses at some Sacramento-area medical facilities are making it a priority to stop bedsores long before they get to that point. Late last month, the Collaborative Alliance for Nursing Outcomes, a national registry tracking nursing patients, recognized 60 hospitals nationwide that have made significant strides in reducing the incidence of pressure ulcers. In Sacramento, these included Kaiser Permanente Sacramento Medical Center, Mercy San Juan Medical Center and the UC Davis Health System.
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“We see them as exemplary performers because we take a look at things like their expenses and patient population and we know that based on research, they are achieving results that are in most cases better than the national benchmarking standards,” said Jacalynn Blankenship, director of clinical practice and quality for the alliance.
Though hospital staff used to think that ulcers only happened to elderly or immobile patients who were bedridden for the long term, new research has showed that the lesions can occur during surgery after just four hours on a hard surface such as an operating table, said Holly Kirkland-Walsh, registered nurse and certified wound-care specialist for UC Davis Medical Center.
Kirkland-Walsh is the director of the eight-member Skin Wound Assessment-Treatment Team, formed at Davis in 2008, which she said was largely responsible for reducing the prevalence of pressure ulcers in the facility to less than 0.5 percent of patients during the most recent quarter. The rate of ulcers at the center has historically been around 2 percent, similar to the current rate nationwide, but has been gradually falling, she said.
The team has focused much of its efforts in recent years on preventing ulcers during operations with new surgical pads and cushions, Kirkland-Walsh said. They have confronted the multiple risk factors for ulcers, including age, activity level and nutrition, resulting in new dietary standards and more early mobility for patients on ventilators. Perhaps most importantly, they’ve circulated the hospital educating nurses on how to spot the ulcers early and how to prevent them. She believes this is the first year the facility has received the Performance Excellence award in this area.
Kirkland-Walsh will soon publish an article in the Association of periOperative Registered Nurses Journal about her research on pressure-mapping surfaces.
“Nurses have always owned wounds,” she said. “Back during the Crimean War, when Florence Nightingale was working as a nurse, wounds were one of the main things she was looking after ... especially these bedsores or pressure ulcers.”
Efforts to reduce pressure ulcers have been underway in California for a long time, and the prevalence is down from where it was 15 years ago, said BJ Bartleson, a registered nurse and vice president of nursing and clinical services at the California Hospital Association.
In 2011, the Centers for Medicare and Medicaid Services stated that hospitals would be financially responsible for anything on its defined list of “provider preventable conditions,” including stage three and four hospital-acquired pressure ulcers. The cost of treating this condition ranges from $500 to $70,000 per individual bedsore, according to the National Pressure Ulcer Advisory Panel, which will host World Wide Pressure Ulcer Prevention Day on Nov. 20.
Hospitals, and nurses in particular, have stepped up their prevention efforts in the hopes of “saving money and, more importantly, providing better care to patients,” Bartleson said.
“Quality isn’t an endpoint,” she said. “It’s an ongoing process to assess what we’re doing – looking at the structure of the facility, the beds, the tables ... (pressure ulcers) are one of the most frequent preventable complications and one which we have a lot of control over.”
At Kaiser Permanente Medical Center, registered nurse and chief nursing officer Clement Miller said preventing ulcers is on the mind of every nurse, every day. Nurses perform a full skin assessment on each patient upon admission to identify factors that might put them at risk for ulcers. Then they continue that observation while turning patients, particularly those who cannot move on their own, once every two hours.
“Pressure ulcers are very risky, and they’re hard to recover from,” he said. “It just seems to be an issue that adds on to other problems that are occurring. It’s important to us to preserve their skin integrity and improve it as early as possible.”
Call The Bee’s Sammy Caiola, (916) 321-1636.