Reducing Pressure Ulcer Prevalence Rates in the Long-Term Acute Care Setting

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Catherine T. Milne, APRN, MSN, BC, CWOCN; Donna Trigilia, APRN, MSN, BC, CWCN; Tracy L. Houle, APRN, MSN, BC, CWOCN; Sandra DeLong, RN, BSN, CWCN; and David Rosenblum, MD

Abstract: Information about pressure ulcer prevalence, prevention, and optimal management strategies in the long-term acute care hospital (LTACH) setting is sparse. Although care processes in other patient care settings have been reported to affect pressure ulcer prevalence rates, the effect of such programs in the LTACH is unknown. To reduce perceived above-average pressure ulcer prevalence rates and improve care processes, a 108-bed LTACH used a failure mode and effects analysis to identify and address high-priority areas for improvement. Areas in need of improvement included a lack of 1) wound care professionals, 2) methods to consistently document prevention and wound data, and 3) an interdisciplinary wound care team approach, as well as a faulty electronic medical record. While prevalence data were collected, policies and procedures based on several published guidelines were developed and incorporated into the pressure ulcer plan of care by the newly established wound care team. Improved assessment and documentation methods, enhanced staff education, revised electronic records, wound care product reviews, and a facility-wide commitment to improved care resulted in a reduction of facility-acquired pressure ulcer prevalence from 41% at baseline to an average of 4.2% during the following 12 months as well as fewer missing electronic record data (<1% of charts had missing data). These study results suggest that staff education, better documentation, and a dedicated wound care team improves care practices and reduces pressure ulcer prevalence in the LTACH. Studies to increase knowledge about the LTACH patient population and their unique needs and risk profiles are needed.

     Wound prevention and management are provided across the healthcare continuum in outpatient clinics, provider offices, home health, and acute, subacute, and long-term care facilities. A long-term acute care hospital (LTACH), a vital part of the healthcare continuum, is a federally recognized healthcare setting with its own reimbursement rules and regulations.

     LTACHs provide specialized acute care for medically complex patients who no longer require the extensive diagnostic testing available at acute care hospitals but still need extended hospitalization.1 To be considered for admission to an LTACH, the individual must require 24-hour, onsite medical care by a physician along with frequent evaluation and management of multiple comorbidities with the potential need for immediate diagnostic imaging, laboratory services, ventilation management, cardiac monitoring, or complex treatment modality changes. Some patients are admitted to receive intravenous therapy services not available in other non-acute care settings. Like acute care, specialized consultation is available. LTACHs differ from chronic care settings in that they focus on comprehensive treatment of critically ill or high-acuity patients using specialized programs geared to the patient’s illness. The goal is medical recovery and return to home and family.2 Unlike rehabilitation centers, qualification for admission does not include patient ability to participate in 3 hours of rehabilitation therapies per day. LTACH reimbursement, like acute care, functions under a diagnosis-related group (DRG) reimbursement system. LTACHs participate in the Joint Commission on the Accreditation of Hospital Organizations (JCAHO) review process and must comply with federal and applicable state rules and regulations regarding patient care. Medicare is one of the predominant payors for LTACH care. Some LTACHs have a specialized rehabilitation component that may be accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).

     Gaylord Hospital is a not-for-profit, 108-bed LTACH located in south central Connecticut.


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Anonymoussays: June 4.2009 at 15:00 pm

Excellent article. This study supports the notion that pressure ulcers are less about patient risk factors and more about the quality of care given. Study after study show that the incidence of pressure ulcers is directly related to the quality of care given and not to patient risk factors. Once we all get that message,stop blaming our high risk patients and begin paying attention to quality prevention measures,the incidence of pressure ulcers will fall. Kenneth Olshansky,M.D.

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