TIP OF THE WEEK
Treating Pressure Ulcers
Most nursing facility residents are likely to be at risk to develop pressure ulcers, according to the RAI Manual.1 However, these wounds, which are also called pressure sores, decubitus ulcers, or bedsores, are one of the most common, preventable, and treatable conditions among the elderly who have restricted mobility. Successful outcomes can be expected with effective preventive and treatment programs.2 With proper treatment, most pressure ulcers will heal. Healing depends on many things, including general health, diet, relieving pressure on the ulcer, and careful cleaning and dressing of the ulcer. Effective pressure ulcer treatment is best achieved when residents, family members, caregivers, and other healthcare providers are involved.
An Agency for Healthcare Research and Quality (AHRQ) guideline publication recommends considering the following elements in your treatment program:3
- Assessment – Involves the entire person, not just the ulcer, and is the basis for planning treatment and evaluating its effects.
- Managing tissue loads – The term “tissue load” refers to the distribution of pressure, friction, and shear on the tissue. Tissue load management is to create an environment that enhances soft tissue viability and promotes healing of the pressure ulcer(s).
- Ulcer care – Initial care of the pressure ulcer involves debridement, wound cleansing, the application of dressings, and possibly adjunctive therapy. In some cases, operative repair will be required. In ALL cases, specific wound care strategies should be consistent with overall patient goals.
- Managing bacterial colonization and infection – Stage II, III, and IV pressure ulcers are invariably colonized with bacteria. In most cases, adequate cleansing and debridement prevent bacterial colonization from proceeding to the point of clinical infection.
- Operative repair of the ulcer – Operative procedures to repair pressure ulcers may include one or more of the following: direct closure, skin grafting, skin flaps, musculocutaneous flaps, and free flaps.
- Education – Education programs should include information on prevention and treatment, assessing tissue damage, and monitoring outcomes.
- Quality improvement – The goal of quality improvement is to develop and implement a systematic, interdisciplinary, and ongoing quality improvement program for facilitating comprehensive, consistent care that can be monitored, evaluated, and changed as patient conditions and current knowledge warrant.
RESOURCE SPOTLIGHT
Set Targets, Achieve Results (STAR) -- http://www.nhqi-star.org/
Join the more than 9,600 nursing homes that use STAR to help continually improve the quality of care they provide to their residents. The STAR site is a Web-based tool that provides methods to set improvement targets, compare to national benchmarks, and track performance goals for six quality measures: physical restraints, high-risk pressure ulcers, depression, chronic care pain, post-acute care pain, and post-acute care pressure ulcers.
IN THE NEWS
CMS LETTER TO SURVEYORS – ISSUED AND EFFECTIVE JANUARY 18, 2008 (PDF)
January 18, 2008 -- CMS -- This memo discusses the survey process and asks surveyors to cite deficiencies based on the regulations, as opposed to the interpretive guidelines.
Read the memo >>
MARCH 1, 2008 -- INDUSTRY-WIDE ENFORCEMENT OF THE NPI COMPLIANCE DATE
January 24, 2008 -- CMS -- Medicare claims without a National Provider Identifier (NPI) number in the primary provider field will be rejected beginning March 1, 2008. If you haven’t already, test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI. If the claims are rejected, call your Medicare carrier or A/B MAC enrollment staff. Read more >>
THE GROWING BURDEN OF DIABETES MELLITUS IN THE US ELDERLY POPULATION
January 28, 2008 -- Frank A. Sloan, M. Angelyn Bethel, David Ruiz, Jr, Alisa H. Shea, and Mark N. Feinglos Arch Intern Med. 2008;168(2):192-199. Read more >>
INDUSTRY EVENTS
Treatment of Pressure Ulcers in the Nursing Home
A national teleconference for members of the Advancing Excellence in America’s Nursing Homes Campaign
February 21, 2008, 2:00 to 3:15 p.m.
Speakers: Steve Levenson, MD, and Debra Bakerjian, PhD, MSN
Click here to register
Medicare Learning Network: Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>
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