Pressure ulcers have long been an issue for patients immobilized for lengthy periods of time. Although in recent years there has been a greater emphasis and awareness regarding prevention of pressure ulcers, starting in October health care professionals will be held financially responsible for patients who develop them.
What are Never Events?
Never events can be defined as events that should not occur, or preventable adverse events. Along with a long laundry list of circumstances and events such as performing the wrong surgery and blood incompatibility errors, pressure ulcers that develop in patients during the course of their hospital stay will no longer be reimbursed, as set forth in the CMS (Centers for Medicare and Medicaid Services).
Why are pressure ulcers being classified as Never Events?
Pressure ulcers are increasing in hospitalized patients, and patients hospitalized specifically for treatment of pressure ulcers have a higher than average length of stay. They can lead to extended lengths of stay, infection, pain, loss of function, and even death. As well, the cost of treating pressure ulcers is approximately $11 billion per year.
What does the new ruling mean for healthcare professionals and their employers
Essentially, the CMS ruling means that if a patient is admitted to the hospital without a pressure ulcer, and subsequently develops a pressure ulcer, the hospital will not be paid for that patient's care.
What effect will this new ruling have on hospitals, long-term care, and home health care?
Obviously, hospitals that have a high incidence rate of development of pressure ulcers will stand to lose a great deal of money; this could greatly impact the financial viability and well-being of the hospital and, by extension, the hospital staff. Considering that the cost of treating a pressure ulcer can be as much as $70,000.00, the need to take steps to prevent ulcers aggressively needs to start now. Facilities that have a program in place to identify and treat patients at risk for the development of pressure ulcers will fare better than those who don't.
There are some facilities that are exempt from the CMS ruling. These include critical access hospitals, long-term care hospitals, Maryland waiver hospitals, hospitals that treat only cancer, and children's inpatient hospitals.
You may be wondering how home care will fare under this new ruling. The implications are ominous for home health care practitioners and their employers. There is no provision under the new CMS ruling that states that pressure ulcers must be healed before patients leave the hospital. This means that home care will then bear the financial responsibility for pressure wounds in patients discharged home with pressure ulcers. Additionally, a difficulty that has been identified in the home care setting is the issue of the healthcare provider's inability to control the patient and the patient's family in terms of compliance with wound care prevention and treatment recommendations. This is very important in terms of performance monitoring and risk management.
What can healthcare professionals do to ensure they are prepared to meet the challenges of the new guidelines?
Prevention, accurate assessment, and documentation of wounds will become even more crucial as of October of 2008. The IHI (Institute for Healthcare Improvement) recommends six steps in the prevention of pressure ulcers:
Assess the skin of all patients upon admission for existing ulcers, and identify those at risk of developing ulcers (i.e. Braden scale)
Reassess the entire skin daily, observing for development of pressure ulcers or worsening of pre-existing ulcers
Assess the patient's risk factors for pressure ulcers daily
Manage moisture properly
Optimize the patient's nutrition and hydration status
Minimize pressure and use pressure minimizing tools properly
In order to meet the new challenges set forth by the new CMS ruling on pressure ulcers, healthcare professionals and agencies must aggressively plan and implement ways to prevent pressure ulcers from occurring. One of the most effective ways to manage this is to ensure that all professionals who deal with at-risk patients are trained in the most current evidence based knowledge available.
Woundeducators.com Woundeducators.com can help to accomplish this goal by providing up-to-date information and training in wound care management. Protect yourself and your facility by engaging in online wound management today, and be prepared for tomorrow.
WoundEducators.com offers comprehensive online wound management training programs designed to educate and prepare health care practitioners to become certified in the rapidly growing field of wound management. Visit us at: woundeducators.com woundeducators.com for more information.
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