Thursday, August 17, 2017

Institute for Pressure Injury Prevention

As the National Decubitus Foundation approaches the close of its efforts, we are glad to be succeeded by the IPIP.  Please visit

The JWOCN reported in their Jan/Feb 2017 issue that the incidence of hospital-caused pressure ulcers has declined by over 50% since 1996.  The NDF is pleased to be able to turn the job of eradicating the hospital-caused pressure ulcer over to the IPIP.

Wednesday, March 8, 2017

National Decubitus Foundation to Close By End of 2017

The Winter 2017 issue of the NDF newsletter, The Ugly Secret, is now available on the NDF website  Please click on "Archive" and select Winter 2017.  In that newsletter we review the history of the NDF, including the groundbreaking report "Reducing Pressure Ulcer Incidence through Braden Scale Risk Assessment and Support Surface Use." (Advances in Skin & Wound Care, July 2008)

A comprehensive survey of acute care hospitals just published in 2017 shows that, since the submission of the NDF study, incidence of hospital-caused pressure ulcers has been reduced from 6.4% to 2.9%.

The Conclusion of the NDF study stated: "Risk assessment of all admitted patients followed by provision of specialized support surfaces to all deemed to be at risk offers real hope of reducing the present very high rate of hospital-caused pressure ulcers".

Many hospitals have adopted this policy leading to the over 50% reduction noted.  The NDF proposes that all hospitals be required to adopt this NDF Prevention Protocol,  now proven to be effective.

Monday, October 31, 2016

If Kaiser Permanente Can Do It, Why Not You?

It is remarkable that the 36 hospitals of the Kaiser Permanente system have achieved an under one percent pressure ulcer incidence rate, while the typical hospital still has an incidence rate of about five percent.  Back in 2006, an NDF paper stated, "Risk assessment of all admitted patients followed by provision of specialized support surfaces to all deemed to be at risk offers real hope of reducing the present very high rate of hospital-caused pressure ulcers."  This procedure came to be known as the "NDF Prevention Protocol".  Evidently Kaiser has put this finding to use.

The NDF will make this our focus for the foreseeable future:  If Kaiser Permanente can do it, why not you?

Tuesday, November 10, 2015

NDF Cofounder Dies

In 1996, following the death of our mother from a hospital-caused pressure ulcer, my brother Gary and I founded the National Decubitus Foundation.  Gary died in September from a rare form of cancer.  Our hope, and even expectation, when we undertook this effort to eradicate the hospital-caused pressure ulcer, was that one or more wealthy individuals whose families had suffered from bedsores would make large donations that would put the NDF on a firm financial footing.  But that has not happened.  In all likelihood this effort will end with our deaths.

But there are some encouraging signs, as reported in the Fall 2015 issue of the NDF newsletter just published today:

1. One of the largest hospitals in Hong Kong has, in effect, adopted the NDF Prevention Protocol by purchasing 300 pressure-relieving support surfaces and providing them to all at-risk patients.  Ulcer formation dropped by over 70%, and further improvement is expected.

2. Many hospitals are following the lead of Kaiser-Permanente and forming their own insurance companies, either on their own or as part of an Accountable Care Organization (ACO).  This completely changes the incentives for bedsore prevention, because hospitals that have already been paid by the patient's annual insurance premium profit greatly by avoiding the expense of  treating pressure ulcers, whereas those being paid for each procedure by the outside insurer gain cash flow by having to treat pressure ulcers.

Tuesday, August 11, 2015

Time for the 'Brute Force' Option

We have written previously about Dr. Lucien Leape, father of the modern safety movement, who has called for "Regulation over Exhortation".  In the May 2013 issue of HealthLeaders he was asked:

"Tell me more about the regulatory agency that would compel patient safety in hospitals, what you call the 'brute force' option."

Dr. Leape answered:

"I was joking about 'brute force'.  What I mean is regulation as opposed to exhortation.  This agency would do what the FAA does, which is to say, 'Here are the standards.  We expect you to follow them.  And we're going to come around and inspect and if you're not doing them, we're going to rap your wrists and expect you to shape up and really get serious about it."

He continued:

"It's inconceivable to me that hospitals can continue to not follow practices that are known to make a real difference"

The NDF wrote Dr. Leape at Harvard suggesting that pressure ulcers constitute a hospital error that his proposed agency should regulate.  He responded, in part:

"I think pressure ulcers are indeed an example of something that health care organizations should be held accountable for.  Failure to prevent them, when we know how, is negligence, pure and simple."

In line with Dr. Leape's thoughts, the NDF plans to concentrate its efforts on educating Congress that pressure ulcers are preventable, and that all hospitals must be required to have on hand sufficient pressure redistribution support surfaces for all admitted patients identified as being at-risk.  This is the NDF "Prevention Protocol".

Monday, January 26, 2015

Hospitals Shown How to Stop Causing Pressure Ulcers

The National Decubitus Foundation, home of the NDF Prevention Protocol,  has created a prominent link on its home page (  to allow hospitals to easily find a mentor who will provide guidance to show the hospital how to stop causing pressure ulcers.  Many hospitals have reduced their bedsore incidence rate to near zero.  Eight of these hospitals have volunteered through the Institute for Healthcare Improvement (IHI) to provide guidance to hospitals that are still causing bedsores.  Now hospitals have no excuse for continuing to cause pressure ulcers.

Thirteen states now require hospitals to post their medical errors, including Stage III and IV pressure ulcers.  The NDF will now concentrate on urging the other 37 states to follow their lead.  Where information is available, the NDF will contact the worst performing hospitals to show them how they can get help. 

Hopefully this is the start of the end of hospitals causing pressure ulcers.

Thursday, September 25, 2014

Is the Pressure Ulcer Problem Solved?

We have discussed here earlier the fact that the former CEO of Kaiser Permanente, George C. Halvorson, in his book Don't let Health Care Bankrupt America, points out that pressure sores can be eliminated when hospitals have the right financial incentives.  "Cash flow has an incredibly powerful impact on the delivery of care.  The specific ways that we channel the flow of cash to caregivers in this country dictates almost all of the care that is delivered by those caregivers."

He points out that most hospitals are paid by an insurance company on a fee schedule for each service performed, so that services for pressure ulcer treatment improve cash flow.  But in a system such as Kaiser Permanente, where the hospital is integrated with the insurance company so that an upfront payment is made for the care of each patient,  the expenses of pressure ulcer treatment subtract directly from hospital profit.

Kaiser, in its over 30 hospitals, has reduced pressure ulcer incidence to under one percent, and many of its hospitals have reported no ulcers in several years.  The IHI has a list of a dozen mentor hospitals that have achieved one percent or lower incidence rates.  And a number of hospitals that have virtually eliminated hospital-caused pressure ulcers are described on the webpage of the National Decubitus Foundation (

It has been reported that there is now a trend toward a Kaiser-like payment model that is "moving quickly like a wave on a beach".  This week the New York Times reported on a new health system that may represent the most important manifestation of this trend to date:

"In a partnership that appears to be the first of its kind, Anthem Blue Cross, a large California health insurance company, is teaming up with seven fiercely competitive hospital groups to create a new health system in the Los Angeles area. The partnership includes such well-known medical centers as UCLA Health and Cedars-Sinai.

"Anthem and the hospital groups plan to announce on Wednesday the formation of a joint venture whose aim is to provide the level of coordinated, high-quality and efficient care that is now associated with only a handful of integrated health systems like Kaiser Permanente in California, Intermountain Healthcare in Utah and Geisinger Health System in Pennsylvania.

"The venture comes at a time of sweeping change in health care, set in motion by the federal Affordable Care Act and intense pressure to reduce the cost of care. Many hospitals are responding by merging and buying doctor's practices, while some are beginning to offer their own health plans for the first time.

"The plan represents a potential alternative in California to Kaiser, popular in the state and a pioneer in managing patient care through sophisticated electronic health records. I think its got the potential to operate very much the same way as Kaiser does said Ms. Boynton, who said many public employees now choose Kaiser.

"Joseph Swedish, the chief executive of WellPoint, the large commercial insurer that owns Anthem and other Blue Cross plans, says the venture is a result of the demand by employers that insurers and providers work more closely on finding better ways of delivering care. This integrated approach I would call game-changing in the Los Angeles marketplace, he said.

"While WellPoint and other insurers are experimenting with alternatives to the current practice of paying doctors and hospitals based on the volume of services they provide, hospitals in the joint venture have agreed to provide care at or below their cost and will share in all of the financial results.
The hospitals must meet certain quality standards to ensure that they are not stinting on care. But Pam Kehaly, a senior executive for Anthem, said the venture was expected to produce significant savings and profit by reducing unnecessary tests and unneeded hospital and emergency room admissions."

Clearly we know how to prevent pressure ulcers when the financial incentives are there.  We must now concentrate on seeing to it that the trend toward integrated healthcare systems continues.