The National Quality Forum (NQF), a voluntary organization that sets consensus standards for health care quality, has adopted a list of 28 "Never Events" and the first condition listed is pressure ulcers stages III and IV. As a result, the Centers for Medicare & Medicaid Services will not reimburse or pay for costs incurred to the patient if a stage III or stage IV pressure ulcer develops while the patient is hospitalized.
The cornerstone of pressure ulcer management is prevention. Recognizing and assessing patients who have not yet developed a pressure ulcer provides a framework for implementation of a prevention strategy that reduces the risk of pressure ulcer occurrence. This in turn can decrease a patient's morbidity and mortality as well as increase comfort and general quality of life.
Most healthcare facilities utilize standardized tools, such as the Braden Scale, to assess risk for developing a pressure ulcer. Dependent upon the calculated level of risk, electronic medical records (EMR) have been beneficial in “planning” what necessary interventions should be implemented. Essentially, the computer either automatically assigns the necessary intervention(s), or it provides a drop down list with suggestions for measures to be implemented. However, checking a box in a computer system does not guarantee an action is always performed.
The cornerstone of pressure ulcer management is prevention. Recognizing and assessing patients who have not yet developed a pressure ulcer provides a framework for implementation of a prevention strategy that reduces the risk of pressure ulcer occurrence. This in turn can decrease a patient's morbidity and mortality as well as increase comfort and general quality of life.
Most healthcare facilities utilize standardized tools, such as the Braden Scale, to assess risk for developing a pressure ulcer. Dependent upon the calculated level of risk, electronic medical records (EMR) have been beneficial in “planning” what necessary interventions should be implemented. Essentially, the computer either automatically assigns the necessary intervention(s), or it provides a drop down list with suggestions for measures to be implemented. However, checking a box in a computer system does not guarantee an action is always performed.
How are sensory perception deficits being managed?
- Is a pressure-reducing surface utilized for a patient with completely limited ability to feel pain or an ordinary hospital bed?
- What other pressure-relieving devices are available for use in the facility?
- How does the staff ensure a patient’s skin stays clean and dry?
- Is there an established bowel and bladder program for urinary or fecal incontinence?
- What measures are applied to ensure increased frequency in turning? How often are patients repositioned? Is a turning schedule utilized?
- Did you know hospital bed manufacturers have mattress surfaces that detect weight-based movement? Can you imagine if this science was adapted to provide the capabilities to record what time the patient was moved and to what degree his/her weight was shifted?
- What products are utilized to lift, turn or transfer a patient?
- What is the elevation of the patient’s head of bed?
- What are the laboratory parameters to determine nutritional status?
- Is dietary intake and body weight being documented accurately and consistently?
Pressure ulcers present a variety of physical, functional and psychosocial issues. Consistent and correct performances of the basic measures can help prevent pressure ulcers as well as heal existing ones. If you have a legal case involving one of these “Never Events,” contact Aguirre Legal Nurse Consulting to assist you in identifying adherences to and deviations from the standards of care.
Source: Centers for Medicare and Medicaid Services, SMDL #08-004, National Quality Forum's (NQF) List of Serious Reportable Events (commonly referred to as "Never Events"), July 31, 2008.
Source: Centers for Medicare and Medicaid Services, SMDL #08-004, National Quality Forum's (NQF) List of Serious Reportable Events (commonly referred to as "Never Events"), July 31, 2008.
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