Abstract
Statement of Problem
Hospital acquired pressure ulcers is an increasing problem and strain on healthcare resources. These types of pressure ulcers should have not occurred in the first place. Starting October 1, 2008, Medicare will no longer paid for the treatment of hospital acquired pressure ulcers and providers are required to treat them without passing the cost onto the patient. Documentation from the doctor and the nurse is acquired to establish the prior existence of the pressure ulcer on admission before reimbursement. Prevention of existing pressure ulcers from advancing to stage III and/or stage IV and prevention of stage I pressure ulcers occurring and advancing was the task this team took on.
Sources of Data
The project took place at St. Joseph's Medical Center in Stockton, California with baseline data taken from the 4th floor to include Respiratory Intensive Care Unit (RICU), Oncology, Respiratory/Telemetry Acute Care Unit, and a Med/Surgical Unit. Data was also gathered from the hospital's CalNOC survey, event reports, and patients' medical records to established if a patient came into the hospital with a pressure ulcer, developed one in the hospital, prevention devices and methods used, and if it advance. Type of documentation or lack of documentation was also explored.
Conclusions Reached
Most nurses know that their patients need to move to keep pressure ulcers occurrences down. However, knowing and actually doing it are two different things. Nurses can document that they turn a patient every two hours, but may not due to lack of time and higher set of priorities taking precedent. Education on how to properly assess high-risk patients, proper use of equipment, encourage mobility in all patients, in-depth documentation, and the teamwork throughout the hospital system of the different disciplinarians is needed to reduce and eliminate hospital acquired stage III and IV pressure ulcers. Nineteen different hospitals nation wide have done it and St. Joseph's Medical Center is on its way to be included on the list.