Pressure Ulcer Surveillance and Its Role in Improved Patient Outcomes
Monday, January 11, 2016
Posted by: Becky Dryden
By: Margaret Goldberg, MSN, RN, CWOCN
As a Past President of the WOCN Society as well as the Immediate Past President of the National Pressure Ulcer Advisory Panel (NPUAP), I have watched the evolution of pressure ulcer prevention and management with particular interest. I was pleased to note that while pressure ulcer prevention has always been an important component of pressure ulcer management, the focus on the prevention of pressure ulcers has greatly increased since the "present on admission" (POA) policy implementation in 2007. This policy directed that there would be no reimbursement for facility acquired pressure ulcers, leading to most facilities keenly pursuing effective prevention strategies rather than the former emphasis on the treatment of actual pressure ulcers.
Most quality improvement programs include some manner of monitoring pressure ulcer management in order to measure the effects of the pressure ulcer program in use. Reviewing whether the prevention tactics are resulting in improved outcomes not only shows how effective the strategies are, it also permits the ability to examine and develop any necessary changes in practice.
AHRQ recommends regularly monitoring:
- An outcome (preferably pressure ulcer incidence or prevalence rates).
- At least one or two care processes (e.g., skin assessment).
- Key aspects of the infrastructure to support best care practices (e.g., clear lines of responsibility for overseeing accuracy of skin assessments.1
In addition to applying evidence-based prevention plans, a recent study (2015) notes that some WOC nurses described various internal and external factors that influenced evidence-based practice. The majority of respondents indicated that key external influential factors included financial concerns, application requirements for Magnet recognition, data sharing among peer institutions and regulatory issues. Internal influential factors were hospital prevention campaigns, the availability of nurse specialists and the level of preventive knowledge among hospital staff.2 These are factors that have not been formerly recognized and consideration of them might be included in pressure ulcer prevention programs.
Facilities should perform routine pressure ulcer prevalence and incidence (P & I) measures in order to track not only their rates of P & I, but the effectiveness of their prevention and treatment strategies. Consistency of methodology is important in order to ensure accurate data, and incidence and prevalence should be measured by consistent measurement variables. Also national benchmarking allows for comparison with other facilities – a very important consideration. There is an ongoing International Pressure Ulcer Prevention (IPUP) survey that is now in its 20th year, with the participation of more than 1,000 facilities that survey more than 100,000 patients over a three-day period. Acute care, long term care, long term acute care, rehabilitation and home care organizations around the world volunteer to participate in the data collection process with aggregate results published in leading journals.4,5 Gathering this data leads to identification of any apparent trends in increasing pressure ulcer prevalence or incidence and allows these to be monitored and carefully addressed.5
In 2001 NPUAP described the incidence of pressure ulcers as ranging from 0.4% to 38% in hospitals, from 2.2% to 23.9% in skilled nursing facilities and from 0.0% to 17% for home health agencies.5 Since then, hospitals have increased their efficiency in pressure ulcer prevention. Incidence rates have dropped from 7% in the 2000s to 4.5% in 2012.6,7
Since most facilities are paying careful attention to rates of pressure ulcer prevalence and incidence, the WOC nurse can prove to be an invaluable resource in the collection and interpretation of this data as well as be the leader in implementing and overseeing quality improvement plans.
- 5. How do we measure our pressure ulcer rates and practices? Agency for Healthcare Research & Quality. http://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool5.html. Published October 2014. Accessed January 11, 2016.
- Padula WV, Valuck RJ, Makic MB, Wald HL. Factors Influencing Adoption of Hospital-Acquired Pressure Ulcer Prevention Programs in US Academic Medical Centers. J Wound Ostomy Continence Nurs. 2015;42(4):327-330. doi:10.1097/won.0000000000000145
- VanGilder C, Amlung S, Harrison P, Meyer S. Results of the 2008-2009 International Pressure Ulcer Prevalence™ survey and a 3-year, acute care, unit-specific analysis. Ostomy Wound Manage. 2009;55(11):39-45.
- VanGilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54(2):40-54.
- Goldberg M. General acute care. In: Pieper B, ed. with the National Pressure Ulcer Advisory Panel. Pressure Ulcers: Prevalence, Incidence and Implications for the Future. Washington, DC: NPUAP; 2012.
- Whittington K, Briones R. National prevalence and incidence study: 6-year sequential acute care data. Adv Skin Wound Care. 2004;17(9):490–494.
- Lyder CH, Wang Y, Metersky M, et al. Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. J Am Geriatr Soc. 2012;60(9):1603–1608.
International Pressure Ulcer Prevention Survey
In its 20th year, the International Pressure Ulcer Prevention (IPUP) survey is the longest running survey focused on pressure ulcers; its results comprise the largest global pressure ulcer database. Each year more than 1,000 facilities participate, surveying more than 100,000 patients over a three-day period. Acute care, long term care, long term acute care, rehabilitation and home care organizations around the world volunteer to participate in the data collection process. The 2016 survey will be conducted on February 23-25, 2016.
IPUP participation helps institutions track and analyze their success at preventing pressure ulcers. IPUP provides participating healthcare facilities with a validated process to determine baseline pressure ulcer prevalence and measure intervention outcomes. Participation is free. Participants receive online data collection tools, training materials and summary reports, and IPUP can also provide customized facility reports and comparison to benchmarks based on the more than 1.4 million patients in the IPUP database.
In addition to providing valuable institutional data, IPUP also includes all the data points required for NDNQI reporting. Participants receive a spreadsheet with relevant data, making compliance simple.
Registration will be closing soon, so interested facilities are encouraged to register immediately at www.hill-rom.com/ipup or by calling 888-467-4839.