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Increasing Pressure Ulcer Awareness

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According to Dr. Aimee Garcia, President of the National Pressure Ulcer Advisory Panel (NPUAP) “over 2.5 million US residents develop pressure ulcers every year. There are more patients who develop pressure ulcers than who develop cancer (annually). The impact of pressure ulcers on the patient, the providers who try to prevent these wounds, and the payers for health care has been underestimated for years.” Certainly, increased awareness about pressure ulcers can help bring about change.

Pressure or decubitus ulcers, commonly referred to as bedsores, are caused when various forms of friction or weight bearing pressure, sustained over a period of time, limit adequate amounts of blood flow to skin tissue causing it to die and a wound or ulcer to form. Therefore, anyone with limited mobility may be susceptible to developing these painful wounds. Individuals with compromised vascular systems or reduced cognizance are at further risk, as are those with various skin conditions due to frailty, nutritional health and weight, incontinence, or physical derma conditions of excessive moisture or dryness.

Typically, bedsores develop over bony prominences or pressure points with surfaces such as the head, hips, elbows, shoulders, buttocks, hips, legs, and feet. As the epidermis deteriorates open wounds can form causing further tissue damage and creating serious health risks for the patient.

The severity of a pressure ulcer is identified by a system of progressive stages I-IV, as well as additional “unstageable” and “deep tissue injury” classifications. The following chart depicts skin and tissue deterioration of each stage:

puimage.jpg(Source: ADAM Medical Encyclopedia)

Pressure ulcers are often difficult to treat, slow to heal, and can cause additional, sometimes deadly complications, such as cellulitis, sepsis, bone or joint infections, or even cell carcinoma. Therefore, it is critical that the sore be appropriately evaluated and documented, and that an aggressive treatment plan be established to manage care. This care often involves healthcare professionals across multiple disciplines including wound-care specialists, dietitians, physical therapists, and surgeons. As you can imagine, this treatment is costly.

According to NPUAP, it is estimated that “pressure ulcers cost $9.1 billion to $11.6 billion per year in the United States with the cost for individual patient care ranging from $20,900 to $151,700 per pressure ulcer.” It is no surprise then, regardless of the debate over whether these infections are “avoidable” or “unavoidable”, that the Centers for Medicare and Medicaid Services (CMS) has classified pressure ulcers, as “never events” or events which should not occur within managed care settings. CMS has denied payment for stage III and IV ulcers since October 2010, prompting nursing and hospital healthcare facilities to take a more active role in preventive care.

When a patient is admitted to a nursing home or hospital they are assessed to determine their risk for developing bedsores. The Braden Scale or Norton tests are often used to evaluate the patient’s level of sensory perception, skin moisture, level of activity or mobility, overall nutritional health, and exposure to forces of friction–all contributing factors to decubitus ulcers. If it is determined that the patient is potentially at risk for such an incidence, the healthcare provider must establish, implement, and continually monitor preventative treatment measures. Skin must be checked regularly and positions shifted. To assist with weight redistribution, pressure relief devices such as special pads or mattresses are often used. In addition, proper incontinence management and patient nutrition must be closely monitored to prevent bedsores.

While these measures can be considered labor intensive for often over-worked or understaffed healthcare professionals, they are easily performed, essential steps for ulcer prevention. The development of decubitus ulcers commonly points to substandard care.

There are times, when even in the presence of proper evaluation and due diligence, pressure ulcers form, causing further detriment to the patient. Where the patient’s condition or debility is such that no intervention at the standard level of care would be deemed effective, it is thought that the ulcer is “unavoidable”.

More often than not however, pressure ulcers are completely “avoidable” with proper care and management. Thus their presence on the “never events” list, identifying them as preventable complications. Bedsores have long been associated with nursing home neglect, however a recent study, of older data, provides the first benchmark for hospital-acquired bedsores and their affects upon patient care.

A clinical study conducted by UCLA’s School of Nursing cited a correlation between hospital-acquired pressure ulcers (HAPU) and increased hospitalization, re-admittance rates, and patient mortality. The study, published in the Journal of the American Geriatrics Society, “found that 4.5 percent of the patients tracked acquired a pressure ulcer during their stay in the hospital. The study also revealed that of the nearly 3,000 individuals who entered the hospital with a pressure ulcer, 16.7 percent developed at least one new bedsore on a different part of their body during their hospitalization.” While the data examined within this study do not reflect current rates of HAPU’s, post CMS policy change, the findings come as no surprise to Briggs & Wholey attorneys who have seen the damage these sores create, first hand, regardless of patient setting. We understand the severity of such injuries and have successfully litigated pressure ulcer cases for our clients in need.

Decubitus ulcers are largely preventable infections, which can quickly deteriorate causing prolonged or recurrent hospitalizations, serious blood infections, painful surgical procedures, disfigurement, or even death. Given the societal and economic costs of this disease, much more attention should be allocated to the study, prevention, and care of such wounds.

If you suspect that a pressure ulcer developed as a result of inferior care received in a nursing home or hospital setting, contact the nursing home abuse and medical malpractice lawyers at Briggs & Wholey, LLC for a free consultation. Our firm has reached multi-million dollar settlements on behalf of patients and their families. Our extensive experience, medical knowledge, and strong trial skills help us receive the compensation your situation deserves.

Additional Resources:
http://newsroom.ucla.edu/portal/ucla/study-spearheaded-by-ucla-nursing-239046.aspx
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb64.pdf
http://www.mayoclinic.com/health/bedsores/DS00570
http://www.cdc.gov/nchs/data/databriefs/db14.htm
http://www.npuap.org