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This article appeared in The Home News Tribune on August 14, 2007
"Bedsores" don't have to be a fact of life
By Denise Gerhab, RN
Correspondent
We used to call them bedsores and we used to think they were inevitable, especially among the elderly and those restricted to beds and wheelchairs.
Today these painful, often debilitating wounds are called pressure ulcers because they are caused by pressure — not by beds. We also know that with the right tools and careful attention, they can be prevented.
Our hospital saw this firsthand when we became part of the statewide Pressure Ulcer Collaborative organized by the New Jersey Hospital Association. By sharing ideas, knowledge and techniques, 150 hospitals, nursing homes and home health agencies reduced the number of new pressure ulcers by more than 70 percent in less than two years. Before the collaborative began in September 2005, 18 percent of New Jersey patients developed some kind of pressure ulcer. That figure dropped to 5 percent by May of this year, according to collaborative participants.
Pressure ulcers are painful, sometimes deadly, skin lesions caused by unrelieved pressure, usually around bony areas. If not treated properly, they can cause infection and destroy tissue, muscle and bone. Nearly 60,000 U.S. hospital patients are estimated to die each year from complications related to pressure ulcers.
They also are expensive to treat. Pressure ulcers strike more than a million U.S. nursing home and hospital patients each year, costing more than $1.3 billion in treatment, according to data provided by the New Jersey Hospital Association. The cost of healing these ulcers can range from $2,000 to $70,000.
Pressure ulcers form when unrelieved pressure squeezes the tiny blood vessels that supply the skin with nutrients and oxygen. Cut off from the blood supply, the tissue dies. Sliding down in a bed or chair is another cause of these types of ulcers. Sliding can stretch or bend the blood vessels, leading to loss of blood supply. Sometimes, even slight rubbing or friction may damage the skin.
Pressure ulcers usually occur on the buttocks, hips, heels, elbows and shoulders, areas of the body that have the most pressure when a patient is lying in bed or sitting for long periods of time. Once a pressure ulcer develops — which can take as little as two hours — it can take months to heal.
As part of the statewide collaborative, representatives from hospitals, nursing homes and home health agencies met for education and information sharing sessions with nationally recognized experts in skin care. We then took back to our facilities so-called best practices to share with our nurses, nursing assistants and aides.
Some of the techniques include doing complete skin evaluations within eight hours of admission and evaluating the risk of skin breakdown using a standardized scale that looks at such factors as the patient's mobility, nutrition, continence, activity and sensory perception.
We held tutorials on assessing and staging ulcers, which had been uneven at most of our facilities. Because pressure ulcers are the result of unrelieved pressure, we emphasized frequently repositioning patients to relieve the pressure. We also learned how best to use positioning pillows, pads or foam wedges to keep bony parts of the body from direct contact with one another. We learned that inadequate caloric intake, a lack of protein or dehydration can lead to the tearing and breakdown of skin.
The information we received resulted in major changes at our hospital. We changed our line of skin care products, ridding the hospital of petroleum-based products that are not absorbed by the skin. We purchased new air mattresses, heel boots and cushions, as well as new beds to relieve pressure. Our dietitians are called in to help at-risk patients with nutrition and hydration. Each unit received a skin care cart, stocked with special dressings, moisturizers and literature on skin and skin care. We created turning schedules and frequently reposition patients so that no one part of the body is under pressure. We provide literature to help educate family members caring for patients at home.
Our hospital's results have been dramatic. For three months of this year, we had no hospital-acquired pressure ulcers among patients in both the acute and skilled nursing units. We were among 48 such institutions in the collaborative to report such results, according to the New Jersey Hospital Association. Our results also earned us an invitation from the Institute for Healthcare Improvement, a non-profit quality improvement organization, to become a mentor hospital.
While our results are impressive, we also know we have to be vigilant. Proper skin care and frequent repositioning of patients must be ongoing activities if we want to make "bedsores" a thing of the past.
Denise Gerhab, RN, BSN, W.C.C, is nursing manager of Care Connection, a skilled nursing unit at Robert Wood Johnson University Hospital at Rahway. Certified in wound care, Ms. Gerhab led the hospital's skin-care efforts for the New Jersey Hospital Association's Pressure Ulcer Collaborative.
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