Despite the fact that long-term care facilities have the most extensive requirements of any U.S. care setting relating to pressure injury monitoring and prevention, approximately one out of three patients in their care will develop pressure injuries — pernicious “never events” also known as pressure ulcers and bedsores. This makes it clear that the status quo must continue to evolve.
Pressure injuries bring with them a wide array of clinical challenges as well as financial and legal consequences for the care provider. However, by focusing on prevention and adopting new technology that can alert clinicians to areas of increased pressure injury risk earlier than current standard care pathways—it is possible to reduce the occurrence of pressure injuries.
The current standard
Clinically, pressure injuries can bring numerous complications, including death. Nearly 60,000 patients die annually as a result of a pressure injury or associated complications; a rate equivalent to the current opioid crisis. Currently, based on the comprehensive assessment of a resident, federal regulations say the facility must ensure that: (1) “a resident who enters the facility without pressure injuries does not develop pressure injuries unless the individual’s clinical condition demonstrates that they were unavoidable”; and (2) “a resident having pressure injuries receives necessary treatment and services to promote healing, prevent infection and prevent new injuries from developing.”
A financial and legal burden
Yet despite the incentive to minimize their occurrence, pressure injuries exact a high price in a number of different ways. For example, in 2017, the overall cost to treat these injuries in the U.S. was estimated in Congressional testimony at more than $25 billion. Separately, the AHRQ has estimated that the annual U.S. treatment cost lay between $9.1 billion to $11.6 billion per year, with the cost of individual patient care ranging from $20,900 to $151,000 per pressure injury.
The situation is similarly stark when viewed from the legal perspective. More than 17,000 lawsuits related to pressure injuries are filed every year and they represent the second-most-common claim for medical malpractice after wrongful death—and even a greater number of claims than falls. Reports of distraught loved ones who allege poor care frequently make headlines. Meanwhile, as reported by Today’s Wound Clinic, plaintiffs are favored in 87 percent of those cases. Increasingly, incidents of pressure sores in long-term care settings are also the cause of criminal action. (For example, McKnight’s reported on the case of a former director of nursing at a Virginia long-term care facility who pleaded guilty to one felony count in a case involving residents with severely infected pressure injuries.)
As a result, pursuing novel measures to promote the prevention of pressure injuries is clearly in the best interest of long-term care facilities and their residents.
The goal might be “zero,” but new technology is essential to support that outcome
Achieving a goal of zero (or nearer to zero) means reexamining current protocols for prevention of pressure injuries and then understanding how new technology should play a role in aiding clinicians.
The current standard of care in pressure injury prevention is based on risk assessment and visual assessment of skin in areas prone to pressure injuries. This approach has several significant challenges; risk assessment tools are subjective and concerns have been raised as to their reliability and by the time damage is visually evident, significant tissue damage has likely already occurred. Visual skin assessment can also be subjective and unreliable as it depends on the clinician’s experience and expertise.
These assessments cannot reliably determine which patients are at increased risk or which patients have existing damage. Vitally, these assessments fail to identify existing damage over specific anatomies; the locations where pressure injuries actually occur. If clinicians could focus on those who have increased risk, and where, they can intervene appropriately; before visible skin damage at specific anatomies. They can then also reduce overtreating patients who are not at risk.
New technology can help by introducing an innovative scanner (www.sem-scanner.com) which uses specialized sensor technology that has been shown to objectively alert carers to specific anatomical areas of a patient’s body, such as the heels and sacrum, that may be at increased risk for pressure injuries.
Several publications and case studies have shown the benefits of measuring sub-epidermal moisture (SEM). In a case study published in The Journal of Wound Care, 32 out of 35 patients had delta values of greater than 0.5 indicating changes that could develop into pressure injuries without clinical intervention. However, none of the 35 patients developed a new pressure injury during their inpatient stay, suggesting that while the delta values indicate damage, further damage was arrested by good interventions. A second publication featuring 284 patients resulted in a 93% reduction in facility-acquired pressure injuries and importantly assessed whether the improvement was based upon a higher focus on pressure injury prevention due to the evaluation—the “Hawthorne Effect.” No evidence of this was found.
Given the high incidence rate and the clinical, financial and criminal consequences of pressure injuries, prevention in long-term care settings should be a renewed prioritized goal. New technology can assist in making this attainable.
Martin Burns is CEO of BBI LLC (Bruin Biometrics).