I'm interested in taking the CWCA exam, but a friend of mine mentioned that the WCC is better. What is the difference between the two?
Results of the 2008 – 2009 International Pressure Ulcer Prevalence™ Survey and a 3-Year, Acute Care, Unit-Specific Analysis
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45 Abstract: The National Quality Forum has identified a pressure ulcer as a hospital-acquired condition (HAC) that is high-cost and high-volume and may be preventable with implementation of evidence-based guidelines. The Center for Medicare and Medicaid Services no longer reimburses acute care facilities for the ancillary cost of facility-acquired (FA) ulcers. Benchmarking patient safety indicators, such as FA, may help facilities reduce pressure ulcer rates. The purpose of this observational, cross-sectional cohort study was to report the International Pressure Ulcer Prevalence Survey™ (IPUP) in the United States in 2008 and 2009. In addition, previously collected data (2006/2007) were used to evaluate and report general and unit-specific prevalence rates in acute care facilities. The overall prevalence and FA pressure ulcer rates were 13.5% and 6% (2008, N = 90,398) and 12.3 and 5% (2009, N = 92,408), respectively. In 2008 and 2009, overall prevalence rates were highest in long-term acute care (22%). FA rates were highest in adult intensive care units (ICUs) and ranged from 9.2% (general cardiac care unit [CCU]) to 12.1% (medical ICU) in 2008 and from 8.8% (general CCU) to 10.3% (surgical ICU) in 2009. In 2009, 3.3% of ICU patients developed severe FA ulcers (Stage III, Stage IV, eschar/unable to stage, or deep tissue injury). In 2009, approximately 10% (n = 1,631) of all ulcers were described as device-related. The most common anatomic locations for device-related ulcers were the ear (20%) and sacral/coccyx region (17%). Both the overall and FA pressure ulcer prevalence rates were lower in 2008 and 2009 than in 2006 and 2007. Results indicate that, although overall prevalence trends are encouraging, there is a stark contrast from the desired state, especially in adult ICUs.
Please address correspondence to: Catherine VanGilder, MBA, BS, MT, CCRA, Hill-Rom, Inc., 8510 Jadewood Drive, Wilmington, NC 28411; email: Catherine_vangilder@hill-rom.com.
Potential Conflicts of Interest: The authors disclose they are all employees of and/or own stock in Hill-Rom, Inc.
A pressure ulcer is a serious complication fraught with pain,1-3 decreased quality of life,4-7 and the expenditure of substantial caregiver time and healthcare dollars.8-12 The formation of a new pressure ulcer while hospitalized has been defined by the National Quality Forum14 (NQF) as a hospital-acquired condition (HAC) that is high-cost and high-volume and may be preventable with implementation of evidence-based guidelines. As of October 1, 2008, the Center for Medicare and Medicaid Services (CMS) no longer will pay for the ancillary cost of care for a facility-acquired pressure ulcer.14 However, HealthGrades, Inc.15 recently reported that 445,028 pressure ulcers developed in almost 14 million Medicare patients (32 cases/1,000 patients) from 2005 to 2007 and cost $2.41 billion in excess healthcare costs, demonstrating a gap from the desired goal. Of the persons who developed ulcers, 42,213 (9.5%) died; however, these were “all cause deaths” and like other reports16 that state that pressure ulcers were not an independent variable for mortality, pressure ulcers may not be the primary cause of death.
Preventing pressure ulcers has become a key focus of many healthcare institutions in the US and throughout the world. Whether all pressure ulcers are preventable is still under debate, but the actions of the NQF and the CMS have refocused pressure ulcer prevention efforts across acute care facilities.
References:
1. Günes UY. A descriptive study of pressure ulcer pain. Ostomy Wound Manage. 2008;54(2):56–61.
2. Reddy M, Keast D, Fowler E, et al. Pain in pressure ulcers. Ostomy Wound Manage. 2003;49(4 suppl):30–35.
3. Krasner D. Using a gentler hand: reflections on patients with pressure ulcers who experience pain. Ostomy Wound Manage. 1996;42(3):20–29.
4. Baharestani MM. Quality of life and ethical issues. In: Baranoski S, Ayello E (eds). Wound Care Essentials: Practice Principles, 2nd ed. Ambler, PA: Lippincott Williams & Wilkins;2008.
5. Price P. Health-related quality of life and the patient’s perspective. J Wound Care. 1998;7(7):365–366.
6. Neil JA, Munjas BA. Living with a chronic wound: the voices of sufferers. Ostomy Wound Manage. 2000;46(5):28–38.
7. Harding K. Complete patient care. J Wound Care. 1995;4(6):253.
8. Alterescu V. The financial costs of inpatient pressure ulcers to an acute care facility. Decubitus. 1989;2(3):14–23.
9. Bergstrom N, Bennett MA, Carlson CE, et al. Treatment of Pressure Ulcers. Clinical Practice Guideline Number 14. Agency for Health Care Policy and Research, Public Health Service. AHCPR Publication No. 95-0642. Rockville, MD: US Department of Health and Human Services;1994.
10. Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatr Soc. 1992;40(8):747–758.
11. Lyder C. Pressure ulcer prevention and management. Ann Rev Nurs Res. 2002;47(3):65–71.
12. Russo CA, Elixhauser A. Hospitalizations related to pressure sores. Statistical Brief #3. AHRQ Healthcare cost and utilization project. April 2006. Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb3.pdf. Accessed January 25, 2007.
13. Centers for Medicaid and Medicare Services. Eliminating Serious, Preventable, and Costly Medical Errors — Never Events. Press Release Thursday, May 18, 2006. Available at: www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863. Accessed July 20, 2009.
14. Ayello EA, Lyder CH. A new era of pressure ulcer accountability in acute care. Adv Skin Wound Care. 2008;21(3):134–140.
15. HealthGrades, Inc. The Sixth Annual HealthGrades Patient Safety in American Hospitals Study. April 2009. Available at: www.healthgrades.com/media/dms/pdf/PatientSafetyInAmericanHospitalsStudy.... Accessed August 21, 2009
16. Thomas DR, Goode PS, Tarquine PH, Allman RM. Hospital-acquired pressure ulcers and risk of death. J Am Geriatr Soc. 1996; 44(12):1435–1440.
17. National Pressure Ulcer Advisory Panel Board of Directors: Cuddigan J, Berlowitz DR, Ayello EA (eds). Pressure ulcers in America: prevalence, incidence, and implications for the future. An executive summary of the National Pressure Ulcer Advisory Panel Monograph. Adv Skin Wound Care. 2001;14(4):208–215.
18. Frantz RA. Measuring prevalence and incidence of pressure ulcers. Adv Skin Wound Care. 1997;10(1):21–24.
19. Institute for Healthcare Improvement. Improvement Report: Relieve the Pressure and Reduce Harm. Available at: www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/ImprovementStories/FS.... Accessed August 25, 2009.
20. Hayden C, Piper E, Malfitano J, et al. Champions Improve Staff Education and Compliance with Pressure Ulcer Prevention Strategies. IHI Improvement Report. Available at: www.ihi.org/IHI/Topics/MedicalSurgicalCare/MedicalSurgicalCareGeneral/Im...). Accessed August 25, 2009.
21. Gibbons W, Shanks HT, Kleinhelter P, Jones P. Eliminating facility-acquired pressure ulcers at Ascension Health. Joint Commission Journal on Quality and Patient Safety. 2006;32(9):488–496.
22. Hiser B, Rochette J, Philbin S, Lowerhouse N, TerBurgh C, Pietsch C. Implementing a pressure ulcer prevention program and enhancing the role of the CWOCN: impact on outcomes. Ostomy Wound Manage. 2006;52(2):48–59.
23. Ballard N, McCombs A, DeBoor S, et al. How our ICU decreased the rate of hospital acquired pressure ulcers. J Nurs Care Qual. 2008;23(1):92–96.
24. Amlung SR, Miller WL, Bosley LM. The 1999 National Pressure Ulcer Prevalence Survey: a benchmarking approach. Adv Skin Wound Care. 2001;14(6):297–301.
25. VanGilder C, MacFarlane G, Meyer S, Lachenbruch C. Body mass index, weight, and pressure ulcer prevalence: an analysis of the 2006–2007 International Pressure Ulcer Prevalence Surveys. J Nurs Care Qual. 2008;24(2):127–135.
26. Halfens RJ, Bours GJ, VanAst W. Relevance of the diagnosis “Stage I pressure ulcer”: an empirical study of the clinical course of Stage I ulcers in acute care and long-term care hospital populations. J Clin Nurs. 2001;10(6):748–757.
27. VanGilder C, MacFarlane G, Meyer S. Results of nine International Pressure Ulcer Prevalence Surveys: 1989–2005. Ostomy Wound Manage. 2008;54(2):40–54.
28. Vollman KM. Ventilator-associated pneumonia and pressure ulcer prevention as targets for quality improvement in the ICU. Crit Care Nurs Clin N Am. 2006;18:453–467.
29. Joint Commission. 2009National Patient Safety Goals. Available at: www.jointcommission.org. Accessed November 2, 2009.
30. American Nursing Association. Nursing Sensitive Indicators. Available at: www,nursingworld.org. Accessed November 2, 2009.
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Is there a 2009 national benchmark for FA pressure ulcers? If so what is the percentage and from which organization?
Reply to this comment »Thank you.
Wendy Calvin
wcalvin@saintpetersuh.com
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