In 2007 the Federal Center for Medicare and Medicaid Services (ref 3) announced that it would no longer reimburse US hospitals for NPUAP stage 3 and 4 hospital-acquired PUs. Hospitals in the US therefore need to develop a prevention model that uses proven interventions. This presentation describes how implementation of one such model resulted in zero prevalence of hospital-acquired PUs. Central to its success is that the programme was a management priority.

3 Center for Medicare and Medicaid Services, 2008

Isabel Bales, RN, MSN, CWON, AGNP
694 West Fort Street • Farmington, Illinois 61531 • USA 

Professional Objective:
To practice as an adult/geriatric nurse practitioner to provide care,
especially to those afflicted with wounds, diabetes, and patients in need of palliative care.
To conduct research that will result in the improvement of patient care.

Credentials:
Professional Registered Nurse       
Certified Wound and Ostomy Nurse  

Certifications:
Wound Care
Ostomy Care

Education:
MSN, University of Illinois at Chicago, May 2009
BSN, Southern Illinois University at Edwardsville, December 2000

Research:
Reaching for the Moon: Achieving Zero Pressure Ulcer Prevalence, 2009
The Development of a Computer-Based Ostomy Care Training Resource for Staff Nurses, 2008
A Comparison Between the use of  Intravenous Bags and the Heelift Suspension Boot to Prevent Pressure Ulcers – 2007

Publications:
Reaching for the Moon: Achieving Zero Pressure Ulcer Prevalence, Journal of Wound Care, 18(4), April 2009
The Development of a Computer-Based Ostomy Care Training Resource for Staff Nurses, 2008,
Publication Pending on the Ostomy and Wound Management Journal

Professional Experience:

2003-Present
WOUND AND OSTOMY NURSE, Methodist Medical Center of Illinois.
• Clinical resource for the acute and rehabilitative care of patients with  selected disorders
of the gastrointestinal, genitourinary, and integumentary systems,  such as complex draining wounds,
ostomies, fistulae, dermal ulcers, tubes, and  incontinence.  Main wound care educator for the nursing
staff.  Primary wound care and ostomy care patient educator. Participate in the development and
implementation of procedures and  protocols.  Recommend standards for cost-effective supplies/equipment
related to wound, ostomy, and incontinence care to be utilized in the hospital through product evaluation.
Chairperson of the wound committee.

 
2002-2003
STAFF NURSE, Methodist Medical Center of Illinois, Transitional Care Unit.
•Assessment of patients, medication administration, treat wounds, implement interventions  following
hospital protocols.  Preceptor and mentor for the unit’s new staff.  Member of  QI committee.  Functioned
as the charge nurse when assigned.

2000-2002
ASSISTANT DIRECTOR OF NURSING, HCR-Manor Care, Canton, Illinois

1998-2000
ASSISTANT DIRECTOR OF NURSING, HCR-Manor Care At Riverview, East Peoria, Illinois

1996-1998
STAFF NURSE, Graham Hospital, Canton, Illinois

Methods: A BIM was developed to investigate the use of different hospital surfaces; standard foam, constant low pressure and alternating pressure surfaces. The model summarizes the cost of PU treatment for patients with existing ulcers and demonstrates whether prevention strategies using pressure relieving surfaces can save hospitals money as a result of preventing PUs in the ‘at risk’ population. The model also provides information on the optimal way in which to adopt appropriate surfaces.  A hypothetical scenario is presented for a typical medium-sized hospital, with more patients placed on pressure relieving surfaces than on standard foam surfaces as previously was the case.

Results: The findings from the hypothetical scenario indicate that when more pressure relieving devices were adopted, there was a reduction in PU development. The associated PU treatment costs reduced substantially, which offset the increased outlay for the surfaces themselves, resulting in substantial cost savings.

Conclusions/Discussion: Our model demonstrates that the implementation of pressure relieving surfaces will reduce the incidence of PUs and generate cost savings. Hence, in order to reduce the strain on hospital budgets that PUs can cause, adopting a planned approach to PU prevention and treatment using pressure relie¬ving surfaces is vitally important.

However, quantification of the problem is complex. Therefore international pressure ulcer guidelines on performing prevalence and incidence studies were (recently) published. The information available in those guidelines will be addressed.
When interpreting prevalence or incidence data, it is important to understand what incidence and prevalence is, which factors influence those figures, and how to interpret and report the data. Also practical issues related to the collection of prevalence and incidence data will be covered.

The need for pressure ulcer prevention strategies is well recognised in clinical guidelines. The appropriate use of pressure-relieving surfaces during hospitalisations is central to the prevention of pressure ulcers. Pressure-relieving surfaces fall into three broad categories: standard foam surfaces, continuous low-pressure surfaces and alternating pressure surfaces. The costs of these surfaces differ substantially. As such, it is vital that healthcare planners and providers ensure that patients are allocated to appropriate surfaces to ensure that prevention strategies are effective and healthcare resources are allocated efficiently. By following best practice guidelines on the appropriate use of pressure-relieving surfaces, hospitals can reduce the pressure ulcer prevalence, while saving money as a result of more efficient use of surfaces and reduced treatment costs.

1 Kaltenhaler, E., Whitfield, M.D., Walters, S.J., Akehurst, R.L., Paisley, S. UK, USA and Canada: How Do Their Pressure Ulcer Prevalence and Incidence Data
Compare. Journal of Wound Care. Jan 2001; 10(1): 530-5.

The measurement and interpretation of pressure ulcer occurrence data has long been problematic in pressure ulcer research, with different definitions of pressure ulceration, differing clinical populations and different data collection methods among some of the challenges faced. This presentation will consider the measurement of pressure ulcer occurrence given that this is a key foundation to achieving evidence of the implementation of successful pressure ulcer prevention strategies. The evidence for changes in pressure ulcer occurrence following the introduction of pressure ulcer preventive strategies will be reviewed. In this section, the focus will be placed upon the impact of the introduction of pressure-redistributing support surfaces as a common tactic to reduce pressure ulcer occurrence. The problems that can arise when attempting to uncover the value of any single tactic used to prevent pressure ulcers will be highlighted and related back to the challenge of correctly measuring pressure ulcer occurrence. The presentation will conclude with recommendations for future pressure ulcer occurrence data collection that should help standardise data allowing more meaningful comparisons between health care providers and trends in pressure ulcer occurrence over time to be made.