Why Progress is Slow

A press release today by researchers at the University of Toronto expresses what many of us have realized for a long time.  It is very difficult to light a fire that gets the attention of the media when it comes to pressure ulcers:

'This slow uptake of quality improvements in pressure ulcer care in Ontario may be connected to the condition's low profile relative to other diseases. "It's one of those diseases that's kind of silent," said Prof. Murray Krahn, principal investigator on the study who is a Professor in the Department of Medicine and the Faculty of Pharmacy at U of T, and Director of THETA.

"Unlike HIV or breast cancer, there are no advocacy groups marching for pressure ulcers. The patients are seniors with co-morbidities and low mobility in long-term care," said Krahn.  Compounding the condition's visibility problem is that it doesn't belong to a particular clinical group. Patients are cared for by nurses, surgeons, infectious disease specialists, general practitioners and internists, so no one group is well-positioned to champion the cause effectively'.

It continues to amaze that the necessary investment in pressure redistribution surfaces would save hospitals a considerable amount, yet most have not made that investment.

Kinetic Concepts Inc. Sold for $5 Billion

KCI is the only manufacturer of the air-fluidized bed other than Hill-Rom that we know of.  About a week ago KCI was sold for 5 billion dollars.  KCI is the manufacturer of the AtmosAir support surface, one of those identified on the NDF website as having been proven effective in preventing pressure ulcers when used in conjunction with the NDF Prevention Protocol.  Hopefully the value of this sale indicates that a strong market for effective support surfaces is expected. 

Thoughts on NDF Website

The New Jersey law requiring all nursing homes to replace all mattresses with pressure redistribution types represents the greatest hope for ending the scourge of bedsores in our lifetime.  I am thinking of redoing the NDF website (decubitus.org) to concentrate on this factor, to convince other states to follow New Jersey's lead, to explain why the requirement must be extended to hospitals, and to raise funds to finance a campaign to educate the legislatures of 49 states.

Promising New Mattress Overlay

We have recently been contacted by Low-G Technologies, LLC.  They have developed a mattress overlay that has now undergone over 40,000 patient days of use without any hint of a pressure ulcer.  We will watch the progress of this product carefully.  This may be an ideal support suface for incorporation into the NDF Prevention Protocol.

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.