I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
A Comprehensive Program to Prevent Pressure Ulcers in Long-Term Care: Exploring Costs and Outcomes
- Wed, 9/3/08 - 10:25am
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Pressure ulcers contPressure ulcers continue to be prevalent and costly for long-term care facilities. A recent document published by the National Pressure Ulcer Advisory Panel revealed a pressure ulcer incidence rate of 2.2% to 23.9% in long-term care.1 Although the cost of pressure ulcer prevention remains elusive, costs associated with their treatment have been conservatively estimated to range from $500 to $50,000 per ulcer,2 with more severe wounds being significantly more expensive to manage than less severe ulcers.3 These costs do not account for the pain and suffering commonly associated with these ulcers. Presently, approximately 1.5 to 3 million adults suffer with pressure ulcers.4 Given the high incidence rates, the need to address pressure ulcer prevention has become paramount. Most recently, the U.S. Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) included pressure ulcers as one of three sentinel events for long-term care5; therefore, the formation of a pressure ulcer or subsequent deterioration of a pressure ulcer can lead to significant monetary penalties (maximum $10,000/day) in long-term care.
Pressure ulcers have become so common in long-term care that federal regulations now articulate pressure ulcer standards or guidelines of care and prevention. In May 1992, the Agency for Health Care Research and Quality (formerly the Agency for Health Care Policy and Research) released Clinical Practice Guidelines6 for the prevention of pressure ulcers. These guidelines provide the healthcare community with current practice parameters based on expert opinion and synthesis of scientific evidence. The Joint Commission for Accreditation of Health Care Organizations (JCAHO) recommends use of the AHRQ clinical practice guidelines. Moreover, the Centers for Medicare and Medicaid Services are using the guidelines to create policy and reimbursement criteria and to direct the federal and state survey process of long-term care facilities.
The AHRQ guidelines for pressure ulcer prevention are meant to be living documents -- that is, providers should implement these guidelines in a cost-effective manner that offers intelligent wound care based on available evidence. How best to implement the standards in long-term care continues to be a challenge, even for discerning administrators and health professionals attempting to maximize resource utilization and balance quality pressure ulcer care. Thus, the purpose of this study was to examine the effectiveness of comprehensive protocols of care (SOLUTIONS®, ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ) focused on risk factors identified by the Braden Scale to prevent pressure ulcers in two long-term care facilities.
Methods
Study design. This quasi-experimental study was conducted in two phases. In Phase I, retrospective medical record abstraction methods were used to ascertain usual (control) pressure ulcer prevention care before the implementation of the comprehensive prevention protocol of care. The retrospective medical record review also was used to determine the cumulative incidence of pressure ulcers for both long-term care facilities. In Phase II, a consistent patient risk assessment (Braden Scale) and the comprehensive protocols of care were introduced in both long-term care facilities (experiment). This study was approved by the Yale Institutional Research Review Board before data collection.
References:
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