NDF Accomplishments in Past 20 Years

As you may have seen in our last newsletter, we have decided to terminate our nonprofit, the National Decubitus Foundation, as of the end of 2017.  During the past 20 years, we have been the only Pressure Ulcer site to publish a methodology for pressure ulcer prevention including statistical evidence that the NDF protocol is effective.  Our research was published in Advances in Skin & Wound Care in July of 2008, "Reducing Pressure Ulcer Incidence through Braden Scale Risk Assessment and Support Surface Use".

My late brother, Gary, and I founded the NDF in 1996 following the death of our mother due to a hospital-caused pressure ulcer.  Our mother, Irene L. Comfort, suffered in hospitals for months while repeated attempts to close her wounds with plastic surgery failed.  Nevertheless, she faced her fate with good spirits and cheerful demeanor, and it is to her memory that all of our efforts to eradicate the hospital-caused pressure ulcer have been dedicated.

While we have not completely eradicated the hospital-caused pressure ulcer, the recently completed International Survey shows that the incidence of facility-acquired pressure ulcers has declined by over 50% during the period of our efforts. Based on some sampling we have done, we believe that most of this decline is due to hospitals adopting what we have come to call the NDF Prevention Protocol. In our 2008 paper, (submitted 2006)  we strongly advocated risk assessment of all admitted patients followed by immediate provision of a proven pressure-reducing support surface to all at risk.

The Journal of the Wound, Ostomy and Continence Nurses Society published "The International Pressure Ulcer Prevalence Survey: 2006-2015" in their January/February 2017 issue.  They found that "Facility-acquired prevalence in acute care declined from 6.4% (2006) to 2.9% in 2015".  

The NDF is indebted to the Christopher and Dana Reeve Foundation for providing the funding needed to allow the distribution of the NDF research results to every acute care hospital in the
United States.

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 www.pressureinjuryprevention.com.


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.

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
www.endbedsores.org.  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.

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?

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.

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".

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 (www.endbedsores.org)  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.