Medicare Publishes List of Worst Performing Hospitals

Medicare has just released the listing of hospitals ranked by their commission of medical errors, including pressure ulcers.  This is an opportunity for the NDF to introduce the worst performers to the NDF Prevention Protocol, and to promise followup on future performance.

Back from Las Vegas

We spent this past weekend in Las Vegas at the NPUAP 12th Biennial Conference.  The NDF had been invited to make a poster presentation. Over 500 medical professionals were in attendance, and a large proportion of those visited our poster and learned about the NDF Prevention Protocol.  About 70 attendees picked up a copy of our 2008 study, published in Advances in Skin & Wound Care, that laid the basis for the protocol.  The NDF presentation will be posted on the website, www.decubitus.org, shortly.

One presentation from the stage provided some very encouraging news.  The National Database of Nursing Quality Indicators, sponsored by the American Nursing Association, for the first time showed a meaningful reduction in hospital-acquired pressure ulcer (HAPU) incidence.  Whereas the incidence for 2004 and 2006-207 held steady at 6.4%,  2010 showed a drop to 3.8% (2.7% excluding Stage 1 ulcers).  The slides from this lecture and all of the other lectures can be viewed at  http://npuap.org/conferences.htm.  

We spoke with the bed manufacturers that displayed at the conference, and verified that many hospitals are investing in pressure reduction support surfaces for prevention purposes, thereby saving large amounts in rental costs.  Other presentations, including one by Dr. Barbara Braden, indicated that on the order of 90% of hospitals are now assessing risk using the Braden Scale within the first 24 hours.  Therefore we feel certain that the very welcome reduction in HAPU is due to the fact that some hospitals have adopted the NDF Prevention Protocol whether they realize it or not.

Require Hospitals to Provide Safe Mattresses

There is now so much evidence that effective pressure reduction support surfaces result in greatly reduced pressure ulcer incidence rates that there can be no question that hospitals must not be allowed to cause bedsores by using inferior mattresses.  All states should pass laws similar to New Jersey's requiring safe mattresses in nursing homes and hospitals. Education is a major focus of the NDF, and we must concentrate on educating state legislators about pressure ulcers and how they can take action to solve the problem.

IHI Mentor Program

The Institute for Healthcare Improvement maintains a Mentor Hospital Registry.  It can be reached from ihi.org by clicking on Programs, then Canpaign, then Mentor Registry.  Twelve hospitals are listed under Pressure Ulcer Prevention, each of which has made great strides in reducing pressure ulcers, some to zero. All twelve list names of mentors along with phone numbers and email addresses.   Nearly all mention purchase of new pressure-reducing surfaces as a factor in their success.  I sent each an email asking what support surfaces they had purchased.  Several responded, and the most mentioned surface was the HillRom VersaCare.

One of the slides for my NPUAP presentation lists hospitals that have achieved a zero level of pressure ulcer incidence, or close to it, with the heading, "If They Can Do It....."

Additional Sources

Today I located some wonderful references.  First of all, a 2008 paper by Amit Gefen, PhD, finds that a pressure ulcer can be initiated in as short a time as one hour.  This provides support to the essential element of the NDF Prevention Protocol that the at-risk patient must be placed on a pressure reducing surface immediately.

The Institute for Healthcare Improvement (IHI.org) under their Programs section has a listing of hospitals that have made significant reductions in hospital-caused PU incidence, and that are willing to serve as mentors to other hospitals.  All of them list new support surfaces as an essential element.  I plan to ask each which support surface they procured.

Most Hopeful Development

The most hopeful development since the "never event" finding by Medicare has been the New Jersey law requiring all nursing homes to replace all beds with pressure redistribution mattresses. Our focus for the foreseeable future should be on educating the other 49 states about what New Jersey has done and asking, "why don't you take the steps needed to stop allowing bedsores?"

Poster Presentation at NPUAP

I have just been notified that our abstract has been selected for presentation at the NPUAP Biennial Conference in Las Vegas Feb 25-26, 2011.  This should be a wonderful opportunity to tell the NDF story, to  expose decision makers from hospitals across the country to the NDF Prevention Protocol.  We will also present preliminary results from our current effort to define the types of support surfaces that are suitable for use with the protocol.