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Wound Care Insights: Whose Fault Are Pressure Injuries?

PART ONE | Pressure injuries: nobody wants them to happen, but they’re an unfortunate - and sometimes life-threatening - reality of healthcare today. When a pressure injury occurs, often blame is the first step. Why?

This is a complicated question that involves many different aspects of the healthcare system as it currently exists. In Part One of this article, we’ll examine some of the reasons behind the blame game around pressure injuries, and in Part Two, we’ll examine some potential solutions.

“Taking a positive approach when a pressure ulcer develops at your health care facility usually isn’t the first thing that comes to mind,” says wound care nursing expert Karen Zulkowski. “However, it should be. When a patient develops a pressure ulcer the first thing that usually happens is the blame game: it wasn’t our fault—it must have happened at the (take your pick) nursing home, hospital, OR, ER, etc. In reality, the pressure may have happened prior to the patient’s arrival at the facility.”

What is the relationship between pressure injuries and quality of care?

The reason for the immediate shift to blame lies in a very old (and incorrect!) set of beliefs about pressure injuries. As far back as 1859, Florence Nightingale wrote, “if he [the patient] has a bedsore, it’s generally not the fault of the disease, but of the nursing.” So pressure injuries are associated most commonly with poor care, or with negligent care: some have even called them a “visible mark of caregiver sin.” (read more) Nobody - not a hospital, not a facility, and certainly no healthcare provider - wants to be the negligent party, and so the rounds of blaming ensue.

Most clinical studies and providers today, however, believe that this is an overly simplistic view of pressure injuries, and that a pressure injury is in reality a failure of teamwork. (This, it should be noted, is a core belief that underlies the entire Skilled Wound Care model, and why we believe that great teamwork is essential to great wound care.) Facilitating better relationships among doctors, nurses, and other caregivers is essential to preventing, spotting, and healing pressure injuries.

Financial penalties of pressure injuries

There are immediate financial penalties associated with pressure injuries as well. Medicare is the predominant payer for health care for the elderly, the patient group most likely to develop pressure injuries. A 2008 decision shifted the burden of spotting, diagnosing, and assessing pressure injuries to physicians/providers, requiring them to perform a skin assessment and document within twenty four hours whether or not a pressure ulcer was present upon admission. If a patient is admitted to a hospital, for example, and such an assessment is not performed within the mandated period, Medicare will assume that the hospital is responsible for the pressure injury, and they will not cover the costs for associated care of the injury. (read more) This reality means that ascertaining the origin of a pressure injury is not just a question of care and responsibility, but a question of an institution’s bottom line.

Pressure injuries are, moreover, incredibly expensive, with an average cost per stay of nearly $40,000 (read more). Pressure injuries are also a common cause of lawsuits, with judgements having been reported as high $312 million in a single case. But a final judgement is not the only financial penalty - even if an institution is found not liable, the financial burden of preparation, depositions, testimony, and legal representation typically stretches for at least two years before it is resolved (read more).

In Part Two of this investigation, we’ll look at some of the possible solutions to the issue, and examine what individuals as well as institutions can do to avoid the blame game, and provide the best possible care to patients. It can be a daunting task, but one truth seems immediately clear: teamwork is a key component to any solution.

Stay tuned for Part Two!

Skilled Wound Care is a mobile surgical practice committed to transforming the chronic wound care model in nursing facilities. Wound care experts make weekly bedside visits to patients in long-term care facilities, avoiding transfers to hospitals or clinics. Our expert physicians give patients the most up-to-date and effective wound treatments, and educate facility staff on how to help patients continue to heal quickly and effectively between visits. This model of collaborative care allows SWC’s physicians to improve patients’ lives and health outcomes, to empower nursing staff, and to raise public awareness. Skilled Wound Care, along with its nurse and nursing home partners, is working every day to positively transform traditional nursing home wound care.

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