Indiana: Pressure Ulcers Reduced By 30%

Health care facilities participating in a state healthcare quality initiative reduced pressure ulcers by 30 percent, the Indiana State Department of Health announced. The reduction occurred at 95 nursing homes, 40 hospitals, and 28 home health agencies participating in the Indiana Pressure Ulcer Initiative. Citing data indicating a high pressure ulcer rate, the initiative was launched in June, 2008.

“The initiative demonstrates how health care quality can be improved through a collaborative effort,” said State health commissioner, Judy Monroe, M.D. The initiative emphasized components such as risk assessments, regular skin inspections, and care coordination between providers. The University of Indianapolis Center for Aging & Community served as project director for the initiative.

Pressure ulcers have been a problem in Indiana health care facilities. For three straight years, the Indiana Medical Error Report cited the development of a stage 3 or stage 4 pressure ulcer while admitted to a hospital as the top reported event. In 2008 surveyors cited nursing homes 186 times for failure to adequately preventpressure ulcers.

Several tools and resources were created as part of the initiative. Six online education modules were created to provide information about pressure ulcers. They are directed at nurse aides and health care staff to assist in entry-level pressure ulcer education. The modules also serve as a resource for patients and families in learning about pressure ulcers. The modules are found on the ISDH pressure ulcer web page at www.in.gov/isdh/24558.htm.

Part of the initiative was the formation of a consumer advisory panel comprised of nursing home residents and families. The panel was instrumental in the creation of a pressure ulcer brochure directed at consumers. This was intended to facilitate communication about pressure ulcers between patients and families and health care providers.

The origins of the initiative date to an October 2007 conference on pressure ulcer prevention presented by the ISDH. Since 2003, Indiana nursing homes had the highest rate of pressure ulcers in the six state region. Medicare data from 2007 indicated Indiana had an 8.7% rate of pressure ulcers in nursing home residents. In December 2008 the rate was at 8.3%. Over the first quarter of 2009, the rate fell to 8.0% dropping Indiana to third in the region. Data shows there was a decrease of 171 pressure ulcers in nursing homes in the first quarter of 2009.

“The cost of treating pressure ulcers ranges from $10,000 to over $40,000 per pressure ulcer,” said Dr. Monroe. “At a cost of $20,000 per pressure ulcer, the reduction of 171 pressure ulcers would result in a savings of $3.42 million dollars. More importantly, preventing pressure ulcers significantly improves the quality of life for Hoosiers.”

The initiative focused on the six essentials of pressure ulcer prevention:

* Assessment upon admission
* Reassess risk daily
* Inspect skin daily
* Manage moisture
* Optimize nutrition and hydration
* Minimize pressure

At the August 26 concluding conference, the ISDH highlighted prevention system improvements such as improved identification of pressure ulcers by over 20 percent and increased daily skin inspections of 25 percent.

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