Monday, July 1, 2013

Take Action on AHRQ Findings

AHRQ Findings Match NDF
Issues Major Report Confirming NDF Protocol
Now that we have the support of the AHRQ, the NDF must take steps to make those results known.  We will write each of the pressure ulcer experts named in the AHRQ report as having contributed to the effort, urging each of them to work at their state level to require that hospitals make the necessary investment in advanced support surfaces. 
The Agency for Healthcare Research and Quality (AHRQ) of the Dept of Health and Human Services is charged with providing evidence-based information so that providers and consumers can make the best possible clinical decisions.  The AHRQ has just released a comprehensive 358 page report (Comparative Effectiveness Review Number 87) reviewing and summarizing all known information bearing on pressure ulcer prevention. The report is entitled "Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness".

This report comes to precisely the same conclusion that the NDF did back in its July 2008 study, "Reducing Pressure Ulcer Incidence through Braden Scale Risk Assessment and Support Surface Use", Advances in Skin & Wound Care, p 330-334. This study forms the basis for the NDF Prevention Protocol, a procedure adopted by many hospitals to effectively drive their pressure ulcer incidence to zero. The protocol consists simply of two elements:
1. Assess the pressure ulcer risk for every patient at admission using the Braden Scale.

2. Immediately place each at-risk patient on a pressure-relieving surface proven to have been effective in pressure ulcer prevention.
As the following excerpts from the conclusions of the AHRQ study illustrate, the AHRQ has also come to the conclusion that only risk assessment followed by support surface use have been demonstrated to be effective pressure ulcer prevention tools:
"Studies of diagnostic accuracy found that commonly used risk-assessment instruments (such as the Braden, Norton, and Waterlow scales) can identify patients at increased risk for ulcers, with no clear difference among instruments in diagnostic accuracy"
"In higher risk populations, good- and fair-quality randomized trials consistently found that more advanced static mattresses and overlays were associated with lower risk of pressure ulcers compared with standard mattresses (RR range, 0.20 to 0.60), with no clear differences between different advanced static support surfaces."
The AHRQ was unable to find any other factor that could be shown to be effective in pressure ulcer prevention:
"Evidence on other preventive interventions (nutritional supplementation; repositioning; pads and dressings; lotions, creams, and cleansers; and intraoperative warming therapy for patients ES-18 undergoing surgery) was sparse and insufficient to reach reliable conclusions.....".