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Medicare News
Medicare Project Proves Pressure Ulcers Can be
Stopped in Nursing Homes
Project stopped over two-thirds of the
residents’ serious bed sores
 Oct. 24, 2007 – Bed sores, pressure ulcers, decubitus ulcers – they are all the same thing – a killer that often
strikes unsuspecting victims in nursing homes. These flesh killers have
been the target the Centers for Medicare & Medicaid Services, which has
just announced a “remarkably effective” effort in preventing them in
nursing homes.
These results, from a “diligent and sustained
focus” on preventing serious bed sores in nursing home residents, is
reported in the Journal of the American Geriatrics Society.
“Reducing pressure ulcers - the clinical term for
bed sores - is a priority for CMS and quality improvement organizations
(QIOs) nationwide,” said Kerry Weems, acting administrator of CMS.
“It is also one of the most important goals of the
voluntary Advancing Excellence in America’s Nursing Homes campaign, of
which CMS is a founding member.”
The nationwide project stopped more than two-thirds
of the residents’ serious bed sores – a dreaded complication of frailty
and disability in old age – in the thirty-five nursing homes that
reported data from the project, the paper reports.
Reducing high risk pressure ulcers is one of the
eight goals of the nursing home campaign and was chosen by 69 percent of
the participating nursing homes as one of the goals they would pursuer.
It was chosen more often than any other goal.
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Nursing Home Quality Campaign Goals
Participating nursing homes will work on at least three of eight
measurable goals:
69.0% Chose #1, far more than any of the other
goals.
1. Reducing high risk pressure ulcers;
2. Reducing the use of daily physical restraints;
3. Improving pain management for longer term
nursing home residents;
4. Improving pain management for short stay,
post-acute nursing home residents;
5. Establishing individual targets for improving
quality;
6. Assessing resident and family satisfaction
with the quality of care;
7. Increasing staff retention; and
8. Improving consistent assignment of nursing
home staff, so that residents regularly receive care from the same
caregivers.
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“This project showed clinicians and managers that
major improvement is possible, even for conditions affecting our most
frail beneficiaries,” added Barry M. Straube, MD, CMS chief medical
officer and director of the Office of Clinical Standards and Quality.
“The results will enable us to separate the serious
pressure ulcers from the superficial ones, a change that will help
beneficiaries and their families to see whether a nursing home has
implemented the best practices available.”
The publication reflects findings that stem from a
collaboration among 52 nursing homes in 39 states, working voluntarily
with experts on process improvement and preventing pressure
ulcers. Participating facilities found that the onset of new serious
bed sores (the ones that go through the skin and often to the bone)
declined 69 percent.
“This is a remarkable gain in a large number of
facilities, against a condition that is as devastating and costly as it
has been resistant to improvement,” said Weems.
“In this case, the work of Medicare’s Quality
Improvement Organizations (QIOs) has helped us refocus our research and
change our data collection and public reporting so that CMS can do a
better job informing residents, family members, and the nursing homes
themselves about nursing home quality.
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About Pressure Ulcers by MedlinePlus
A pressure ulcer is an area of skin that breaks
down when you stay in one position for too long without shifting your
weight. This often happens if you use a wheelchair or you are bedridden,
even for a short period of time (for example, after surgery or an
injury). The constant pressure against the skin reduces the blood supply
to that area, and the affected tissue dies.
A pressure ulcer starts as reddened skin but gets
progressively worse, forming a blister, then an open sore, and finally a
crater. The most common places for pressure ulcers are over bony
prominences (bones close to the skin) like the elbow, heels, hips,
ankles, shoulders, back, and the back of the head.
These factors increase the risk for pressure
ulcers:
● Being bedridden or in a wheelchair
● Fragile skin
● Having a chronic condition, such as diabetes or vascular disease,
that prevents areas of the body from receiving proper blood flow
● Inability to move certain parts of your body without assistance,
such as after spinal or brain injury or if you have a neuromuscular
disease (like multiple sclerosis)
● Malnourishment
● Mental disability from conditions such as Alzheimer's disease --
the patient may not be able to properly prevent or treat pressure ulcers
● Older age
Urinary incontinence or bowel incontinence
>>
More about pressure ulcers
>>
More about pressure ulcers at Wikipedia
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Because serious bed sores often develop before a
patient enters a nursing home, the project’s teams often encouraged
hospitals, home health agencies, and emergency services to collaborate
to identify and reduce causes of bed sores. The project also found that
direct care providers—often certified nursing assistants—could be
effective leaders of quality improvement efforts.
“This kind of project shows how valuable Medicare
can be as a responsible public health agency and much more than just a
payer of healthcare services,” said Weems.
“CMS aims to continuously improve care, learn and
share the methods that improve care, and inform providers and the public
about changes that can become standards for quality of care.”
Qualis Health, the QIO for Washington State,
coordinated the project for CMS. The QIO Program consists of 53
independent organizations under contract with CMS and is a key component
in CMS’ efforts to improve quality in nursing homes and other healthcare
settings, including hospitals, home health agencies, and physician
offices.
The improvement materials used in this project are
available to anyone interested in improving the care of bed sores, free
of charge, on the Medicare Quality Improvement Web site at:
www.medqic.org (under the “Nursing Home” tab)
For more information on the voluntary campaign and
its eight quality improvement goals, visit
www.nhqualitycampaign.org.
Pressure Ulcer Success Story
Central Montana Skilled Nursing Center Honored
After fifteen months of intense efforts to improve
its systems of pressure ulcer care, Central Montana Skilled Nursing
Center was recognized for outstanding progress by Mountain Pacific
Quality Health, the Medicare quality improvement organization (QIO) for
Montana. The Lewistown facility received an Outstanding Achievement
Award for results achieved during its participation in the Montana &
Wyoming Nursing Home Pressure Ulcer Collaborative, which was sponsored
by the Helena-based QIO.
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