How to avoid wound care fines
Bardia Anvar, M.D.
A patient is administered the wrong medication, an unattended resident falls and injures himself after taking a shower, a staff member punches a resident in “self defense,” a resident falls while being moved from his bed to a wheelchair, a nurse forgets to turn on the oxygen tank for her COPD patient…such incidents occur everyday in nursing homes and assisted care facilities all across the country. Not only do such errors place patients/residents in danger, but they cause families grief and leave operators facing hefty fines and the possibility of being closed down.
As the federal, state and county oversight agencies continue to scrutinize nursing homes and assisted care facilities, it is critical that those who care for the elderly the ill be properly trained and strict rules and regulations be drafted and followed diligently.
While most of the incidents described earlier are easily avoidable by establishing and following rules and regulations, there is one area of concern for such facilities not quite as simple to rectify – caring for pressure ulcers and wounds. According to the Centers for Disease Control, as many as 1 in 10 nursing home/assisted residents suffer from these sores and, if not properly treated, can be fatal.
Such wounds, also called bed sores, have long been a problem and regulatory agencies are cracking down like never before. Because one's skin becomes thinner and begins breaking down over time, the elderly are more susceptible to pressure wounds. The ulcerations, which can develop in as little as two hours, may be caused by constant pressure to a particular area of the body – mostly hips and buttocks, or a lack of blood flow that tends to affect the lower extremities.
Improper lifting and turning are two of the most common causes of skin tears, which can be avoided by using sheets to help shift the body's position. Skin on skin contact leaves the elderly vulnerable to tears so they should be clothed in long sleeves and stockinettes. If a wound develops, avoid using hydrogen peroxide or Dakins Solution as these kill healthy tissue and impede the healing process.
Up until now, wound treatment was exorbitantly expensive. While the average hospital stay for the elderly is five days at a cost of $10,000, pressure ulcer wound-related stays are typically 13 or 14 days with costs ranging from $16,755 and $20,430 and that's not including expensive ambulance transportation to and from the hospital.
But many of these facilities are contracting with services that specialize in wound prevention and treatment – a far more effective and less costly approach.
At Skilled Wound Care we are seeing higher-than-average success rates of treatment with an average of 60% of these wounds being healed right at the onset intervention. Wounds with necrosis, slough or bio-burden are typically debrided with 70% of them decreasing in size by 25% in the first month. A recent internal study of a 2,300-bed nursing home chain reduced its in-house pressure ulcer rate by 33%.
We offer the following tips for wound prevention:
- Change the patient's position every 15 minutes for those in a wheelchair and every two hours for those bedridden
- Avoid having them lie directly on their hip bones
- Use a pressure-reducing mattress
- Clean and inspect patient's skin daily and if you notice anything unusual, seek medical attention immediately
- Ensure they eat nutritious meals and stay hydrated
- Encourage exercise if possible to increase blood flow and release endorphins, which will brighten his or her mood
Board-certified general surgeon Bardia Anvar, M.D. is medical director of Skilled Wound Care, which services nursing facilities, patients and health plans throughout the United States for wound care.