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.

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 (www.endbedsores.org).

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.

Promising Developments

Several news reports have been published in the past few weeks indicating that both insurers and hospitals are searching for new ways to provide insurance payments. As has been discussed earlier, reimbursing for each procedure involved in treating pressure ulcers does not work to prevent ulcers; in fact, this method of payment only adds to the hospital's cash flow. But paying upfront for prevention provides a strong incentive for hospitals to avoid all of the additional expenses incurred when they allow a patient to develop a pressure ulcer. This has been shown to be the reason that Kaiser Permanente hospitals have been able to reduce their rate of pressure ulcer incidence to virtually zero.

We will include several of these promising articles in the upcoming NDF Summer 2014
issue of The Ugly Secret.

IS THIS WHY HOSPITALS WON'T STOP?

The name of this blog is "Why won't hospitals stop causing bedsores?". Ever since we submitted our paper in 2006 showing how a handful of hospitals had reduced bedsore incidence to near zero, we have had to wonder why all hospitals did not follow their example.

A book has just been published that explains why this may never happen unless the method of hospital compensation by insurance companies changes dramatically.  George C. Halvorson, former CEO of Kaiser Permanente, is the author of "Don't Let Healthcare Bankrupt America."  Mr. Halvorson writes:

"Pressure ulcers are a perfect example of the perverse way we pay for care today.  Seven percent of the hospital patients, on average, end up with a pressure ulcer in American hospitals.  The best hospital care sites in this country now have less than one percent of their patients getting pressure ulcers.  The very worst care sites have upwards of ten percent or their patients getting pressure ulcers.

"Ten percent ought to be regarded as an unforgivable number. Seven percent should also not be an acceptable percentage by hospital care teams. Some of the very best hospital care sites have managed to go for more than a year without one single stage-two or higher pressure ulcer. Not one.  That is amazing patient-centered, patient-focused care.

"By contrast--a lot less money is spent at the best sites, and more patients survive at those best sites....those best hospitals also make a lot less money from each ulcer patient and from pressure ulcers overall. Based on the way we buy care today in this country, the reward for doing well is to get paid less.

"...the payers who use the insurance fee schedules to define the care they pay for will cough up an average of $40,000 in fees to the care site for each pressure ulcer patient....Doing all the things needed to keep those ulcers from happening are not accepted as billable sources by the fee schedule that is usually used to pay for approved care -- so very few fee-based care sites do that preventive work....There is also no fee to have the highest risk patients in beds that have special liners.

"The care priorities and the care delivery approaches that result from a flat payment approach for a package of care can be very different than the priorities that are a fact of life for a fee-based piecework payment business unit.

"Kaiser Permanente is one of those prepaid care teams that sells care by the package and not by the piece.  With three dozen hospitals, 550 medical care sites, 180,000 caregivers, and 9 million members, Kaiser Permanente is paid a flat fee every month for each of the 9 million members, and uses that money to provide the care needed by the 9 million people....Being freed from the tyranny and structure of a piecework cash model allows the care teams to focus on the patients.

"The pressure ulcer work at Kaiser Permanente has gotten continuously better. the care model of being paid by the package rewards continuous improvement.  With that payment model, the ulcer level has dropped from 3 percent to 2 percent of patients and now it averages less than 1 percent.....Some Kaiser Permanente hospitals have not had one single pressure ulcer for more than a year."

"Patients who get these ulcers are often in great pain.  Some are damaged for life.  Some are badly disfigured.  Some die.  Getting a pressure ulcer is not a good thing for a hospital patient.

"So how does the business model we use now to pay for care deal with these major differences in performance for care sites relative to pressure ulcers?

"Very badly or very well - depending on whether you are paying for those ulcers or charging fees to treat those ulcers.

"Care actually costs a lot more at the worst care sites.  Those sites get paid more money because they deliver poor care.  A lot more cash flows to the very worst care sites. Patients are individually damaged at those worst care site and the way we buy care today, the sad truth is that the cash flow for those poorly performing care sites increases significantly as their care deteriorates."

Are our efforts to inform hospitals how the best performing hospitals are eliminating bedsores all in vain until we are able to change the business model?  Is the profit motive so strong that hospitals continue causing pressure ulcers that they know how to eliminate?

Flap Fails to Close

A recent press release from JusticeNews Flash.com (Clinitron Bed Management For Flap Patients Is The Standard Of Care, 2013-06-19) brought back angry memories of my mother's hospitalization and death.  For exactly the reasons stated in the press release quoted below,  the hospital and the plastic surgeon refused to pay to rent the air fluidized bed that is the standard of care for flap patients.  Her surgery failed three times, and only one night in all that time was she allowed to have the Clinitron bed.

"Patients, providers, and families expend great effort in attempting closure of Grade 3 and Grade 4 decubitus ulcers. Patients die, become progressively debilitated, suffer a loss independence, and become progressively depressed directly because of decubitus ulcers. All necessary and appropriate care must be utilized for these patients, and that would include the use of clinitron beds after flap closure. Cost cutting and the rationing of state of the art medical care should not compromise this unfortunate population and all attempts must be made to obtain a successful flap outcome. The prospect of using less expensive beds that have inferior pressure relieving capabilities is a repulsive idea that is the result of unjustified rationing of medical services brought on by aggressive hospital administers trying to save cost and the expense of patients who suffer from chronically disabling conditions."

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.....".  

AHRQ Finds NDF Was Right

Back on October 12, 2013, we wrote the Agency for Healthcare Research and Quality (AHRQ) of the US Dept of Health and Human Services to comment on their publication,  Preventing Pressure Ulcers in Hospitals - A Toolkit for Improving Quality of Care.  The AHRQ Toolkit included a wide variety of activities, including turning, repositioning, nutrituional aupplements, pads and dressings, lotions and cleansers, etc.

We wrote that their toolkit was unnecessarily complicated and detailed, and urged the adoption instead of the NDF Prevention Protocol:

               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 production.
                            
In reply the AHRQ wrote that "The hospital is given the option to customize its prevention strategy based on the tools provided".  (This has been the case forever with no discernable improvement - ed.)

But this month (May 2013) the AHRQ has published its 400+ page comprehensive Comparative Effectiveness Review number 87, Pressure Ulcer Risk Assessment and Prevention: Comparitive Effectiveness.  In this exhaustive report the AHRQ was able to make only three definitive statements:

1." ...commonly used risk assessment instruments (such as the Braden, Norton, and Waterlow Scales) can help identify patients at increased risk for ulcers.."

2." ....randomized trials consistently found that more advanced static support surfaces were associated with lower risk of pressure ulcers compared with standard mattresses in higher risk patients with no clear differences among different advanced static support surfaces."

3. "Evidence on effectivenes of other preventive interventions (nutritional supplementation; repositioning; pads and dressings; lotions, creams, and clensers; ...) compared with stand care was sparse and insufficient to reach reliable conclusions."

Evidently the AHRQ has convinced itself that the NDF Prevention Protocol is the only thing that makes sense.

How Widespread is this Despicable Practice?

The March 2013 issue of Advances in Skin & Wound Care contains an article, "Construct Validity of the Moisture Subscale of the Braden Scale for Predicting Pressure Sore Risk"   by Omolayo, T et al.  One of the factors contributing to moisture in the Braden Scale is incontinence.

"The authors were surprised to find incontinence briefs in use among participants who are reported to be continent.  It appears briefs are used when residents cannot reach the commode in a timely manner or when nursing assistants are unable to respond promptly to resident calls. Briefs become a toileting alternative. This economy of effort is not consistent with the goals of mobilizing residents to prevent muscle weakness, decrease incontinence, and prevent PrU's.  Toileting deserves more attention.  If residents receiving rehabilitation services are encouraged to use briefs instead of walking or being assisted to the commode, it is possible that mobilization and bladder training controls are not being met. This may delay rehabilitation or result in longer nursing facility care.  There is evidence that bladder training and mobilization can be improved with regular toileting, and this should be a goal of care.  One study of culture of care in two nursing facilities demonstrated that, even in a setting with a strong culture of care, a commitment to continence care and incontinence prevention was not fully embraced."

Evidently many facilities are using diapers to replace nursing assistants, thereby saving money and increasing profits.  This is exactly what happened to our mother in the hospital, leading to her pressure ulcers and her death. This despicable practice must stop.  An investigation is needed  to see how widespread this practice is.

NY State Bill Would Require NDF Protocol in Hospitals

The NDF has been contacted by a representative of the NY State Legislature to inform us that a bill modeled after the New Jersey Law is making its way through the State Senate.  The New York bill covers hospitals as well as nursing homes, whereas the New Jersey law includes nursing homes only.  Hospitals   would be required to have on hand sufficient pressure-relieving mattresses to be provided to every pressure ulcer at-risk patient upon admission to the hospital.

It was explained that this is something some members of the legislature have wanted to do for some time, but the results of the last election had only now made possible.  We were also told that when New York passes such a law, other states are likely to follow.  The law will be known as "Nellie's Law".   This is an extremely hopeful development as we continue to strive for eradication of hospital-caused bedsores.

Amazing Wonderful News

The most hopeful news we have seen has just been announced by the Collaborative Alliance for Nursing Outcomes.  The current issue (Jan 2013) of Advances in Skin & Wound Care contains a research paper, "Eliminating Hospital-Acquired Pressure Ulcers: Within Our Reach".  The  authors used records from 78 hospitals, mostly in California, over the period 2003-2010, and found that, on average, the rate of hospital-acquired pressure ulcers (HAPU) had decreased steadily from 11% to 2%. Pressure ulcers of Stage III and above had decreased from 2% to .4%.

All of the hospitals included in the study were non-profit or government facilities.  This is extremely promising data and we can only hope that for-profit facilities may be shown to have done as well.

How did these hospitals achieve these very promising results? The authors state:

"The most commonly reported interventions were protocol development, staff education, new use of a risk assessment tool, performance monitoring, development of a team approach, use of new beds/support surfaces, implementation of guidelines, providing feedback to staff, and linking staff with resources."

Clearly, the only substantive changes in this list are the use of a risk assessment tool and the purchase of new beds/support surfaces. All of the other items mentioned are just staff guidelines for implementation of the new protocol. That new protocol is the NDF Prevention Protocol as described in our  report, "Reducing Pressure Ulcer Incidence through Braden Scale Risk Assessment and Support Surface Use", submitted July 5, 2006 and published July 2008 in Advances in Skin & Wound Care.  We are extremely gratified to have this confirmation of the efficacy of the NDF Prevention Protocol, whether the hospitals involved realize they were using the NDF protocol or not.

Promising Developments in Early 2013

The State of Connecticut has strong requirements for hospital reporting of adverse events.  This year, hospitals reported a rate of serious pressure ulcer development at only half of that reported last year.  Dr. Mary Reich Cooper, vice president and chief quality officer for the Connecticut Hospital Association, said the state’s hospitals are making extensive efforts to identify patients at risk of ... pressure sores upon admission. 

The Greater New York Hospital Association, a trade association comprising hospitals in New York, New Jersey, Connecticut and Rhode Island, just announced their free organizational assessment of a pressure ulcer prevention and management program.  The program requires that "all consumers receive a comprehansive skin inspection and risk assessment by a registered nurse at time of initiation of services by your organization".  Interventions to be considered for all at-risk patients include "pressure reduction, off-loading, pressure redistribution, the need for special mattress....devices."

Little by little, we believe the essentials of the NDF Prevention Protocol (Advances in Skin & Wound Care, July 2008) are being acted upon by hospital officials.

Today is "Stop Pressure Ulcer Day'

'Stop Pressure Ulcer Day' was created by the "Declaration of Rio de Janeiro" in 2011.  This effort has been recognized by the European Pressure Ulcer Advisory Panel, who issued the following statement:

" In recent years we have seen 'Stop Pressure Ulcer Days' occurring in Spanish-speaking countries, and last year these organisations created a Declaration in Rio speaking out against people developing pressure ulcers. In 2012 there will again be a Stop Pressure Ulcer Day to be held on November 16th 2012. The European Pressure Ulcer Advisory Panel applauds the efforts of such events to bring pressure ulcers to the public, the professionals and our politicians. EPUAP has decided to join the Stop Pressure Ulcer Day to help publicise pressure ulcers...."

This is a wonderful development that should be brought to the attention of local newspapers, hospitals, and local and national politicians.  The NPUAP expressed their support just yesterday, stating "Over 2.5 million US residents develop pressure ulcers every year.  There are more patients who develop pressure ulcers than who develop cancer every year."

Your Contributions are Important

The National Decubitus Foundation is presently concentrating its efforts on urging states to require full disclosure of medical errors by hospitals, including Stage III and IV pressure ulcers.  This is an expensive and time-consuming process, but we believe it to be the most effective way of exposing those hospitals that continue to cause bedsores, and getting them to adopt the NDF Prevention Protocol. 

Please join in the fight to make hospitals accountable by contributing now.  Thank you.

UCLA Findings Confirm NDF Recommendations

The UCLA School of Nursing has published a study showing that those hospital patients allowed to develop a bedsore have a significanly increased chance of death.  This study, in the September issue of the Journal of the American Geriatrics Society, only confirms the NDF study of July 2008 in Advances in Skin and Wound Care.  The NDF study stated "Pressure ulcers are a significant cause of death in hospitals, although the recorded cause of death often disguises this fact."

The UCLA study states "This is a serious issue, and now we have data that can help the healthcare system address this ongoing problem.  Individuals entering the hospital with the risk conditions that we've identified should send up a immediate warning signal that appropriate steps should be taken to minimize the chance of pressure ulcers occuring."  This is exactly the procedure identified by the NDF Prevention Protocol, where risk conditions are identified by use of the Braden Scale, and the steps to be tken involve immediate use of the appropriate supporrt surface.

The UCLA study also found that of 3000 patients identified as entering the hospital with an existing bedsore, 16.7 percent developed at least one additional bedsore on a different part of their body.  This is strong support for the NDF position that all hospitals must be required to invest in sufficient pressure relieving support surfaces to accomodate all at-risk patients at admission.