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Peter R Worsley, Glenn Smith, Lisette Schoonhoven, Dan L Bader
AIM: The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). DESIGN: A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. METHODS: Demographic and pressure ulcer related data were collected from patients at risk of developing a pressure ulcer, collated by a single observer using a standardized tool...
July 2016: Nurs Open
Richard F Averill, John S Hughes, Richard L Fuller, Norbert I Goldfield
The Partnership for Patients (PfP) and the Agency for Healthcare Research and Quality (AHRQ) have reported a 23.5% decline in hospital-acquired pressure ulcers (HAPU) over 4 years resulting in a cumulative cost savings of more than $10 billion and 49 000 averted deaths, claiming that this significant decline may have been spurred in part by Medicare payment incentives associated with severe (stage 3 or 4) HAPUs. Hospitals with a high rate of severe HAPUs have a payment penalty imposed, creating a financial disincentive to report severe HAPUs, possibly contributing to the magnitude of the reported decline...
August 30, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
William V Padula, Robert D Gibbons, Peter J Pronovost, Donald Hedeker, Manish K Mishra, Mary Beth F Makic, John Fp Bridges, Heidi L Wald, Robert J Valuck, Adam J Ginensky, Anthony Ursitti, Laura Ruth Venable, Ziv Epstein, David O Meltzer
OBJECTIVE: Hospital-acquired pressure ulcers (HAPUs) have a mortality rate of 11.6%, are costly to treat, and result in Medicare reimbursement penalties. Medicare codes HAPUs according to Agency for Healthcare Research and Quality Patient-Safety Indicator 3 (PSI-03), but they are sometimes inappropriately coded. The objective is to use electronic health records to predict pressure ulcers and to identify coding issues leading to penalties. MATERIALS AND METHODS: We evaluated all hospitalized patient electronic medical records at an academic medical center data repository between 2011 and 2014...
August 18, 2016: Journal of the American Medical Informatics Association: JAMIA
William D Spector, Rhona Limcangco, Pamela L Owens, Claudia A Steiner
BACKGROUND: Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). OBJECTIVE: To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. RESEARCH DESIGN AND SUBJECTS: Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012...
September 2016: Medical Care
William V Padula, Robert D Gibbons, Robert J Valuck, Mary B F Makic, Manish K Mishra, Peter J Pronovost, David O Meltzer
BACKGROUND: In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. OBJECTIVE: To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. MATERIALS AND METHODS: We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement...
May 2016: Medical Care
David Pickham, Betsy Ballew, Kristi Ebong, Julie Shinn, Mary E Lough, Barbara Mayer
BACKGROUND: Pressure ulcers are insidious complications that affect approximately 2.5 million patients and account for approximately US$11 billion in annual health care spending each year. To date we are unaware of any study that has used a wearable patient sensor to quantify patient movement and positioning in an effort to assess whether adherence to optimal patient turning results in a reduction in pressure ulcer occurrence. METHODS/DESIGN: This study is a single-site, open-label, two-arm, randomized controlled trial that will enroll 1812 patients from two intensive care units...
2016: Trials
Katie Swafford, Rachel Culpepper, Christina Dunn
BACKGROUND: Hospital-acquired pressure ulcers (HAPUs) are a costly and largely preventable complication occurring in a variety of acute care settings. Because they are considered preventable, stage III and IV HAPUs are not reimbursed by Medicare. OBJECTIVES: To assess the effectiveness of a formal, year-long HAPU prevention program in an adult intensive care unit, with a goal of achieving at least a 50% reduction in 2013, compared with 2011. METHODS: Planning for the prevention program began in 2012, and the program was rolled out in the first quarter of 2013...
March 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Seval Hanonu, Ayise Karadag
Pressure ulcers do not develop only in areas with bony prominences; they can develop in any tissue under pressure, including pressure exerted by medical devices. A prospective, descriptive study was conducted from December 15, 2013 to March 25, 2014 to determine the prevalence, risk factors, and characteristics of medical device-related hospitalacquired pressure ulcers (MDR HAPUs) among all patients (N = 175) in 5 adult intensive care units (ICUs) in a university hospital in Turkey. The previously established point prevalence of hospital-acquired pressure ulcers (HAPUs) in these ICUs was 15%...
February 2016: Ostomy/wound Management
Christina Fabbruzzo-Cota, Monica Frecea, Kathryn Kozell, Katalin Pere, Tamara Thompson, Julie Tjan Thomas, Angela Wong
PURPOSE: The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. BACKGROUND: Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. RATIONALE: Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families...
March 2016: Clinical Nurse Specialist CNS
M Elizabeth Beal, Kimberly Smith
BACKGROUND: A national goal was set in 2004 for decreasing hospital-acquired pressure ulcers (HAPUs). A mean to achieve that goal was initiated in 2005 with long-term care facilities. Acute care facilities, with encouragement from the Centers for Medicare and Medicaid Services, took action. AIMS: Pressure ulcer prevention efforts at MaineGeneral Medical Center (MGMC), a 192-bed acute care hospital in Augusta, Maine, sought to reduce HAPU prevalence from a mean of 7...
April 2016: Worldviews on Evidence-based Nursing
H van der Wielen, M W M Post, V Lay, K Gläsche, A Scheel-Sailer
STUDY DESIGN: Prospective observational cohort study. OBJECTIVES: To describe time to occur and time until closure of hospital-acquired pressure ulcers (HAPUs) in patients with spinal cord injury (SCI). SETTING: Specialised SCI acute care and rehabilitation clinic in Switzerland. METHODS: Daily registration of the presence and severity of HAPUs in a consecutive sample of SCI patients during their entire in-patient stay...
September 2016: Spinal Cord
William V Padula, Leon Blackshaw, C Tod Brindle, Samuel L Volchenboum
Changes in the methods that individual facilities follow to collect and store data related to hospital-acquired pressure ulcer (HAPU) occurrences are essential for improving patient outcomes and advancing our understanding the science behind this clinically relevant issue. Using an established electronic health record system at a large, urban, tertiary-care academic medical center, we investigated the process required for taking raw data of HAPU outcomes and submitting these data to a normalization process...
January 2016: Journal of Wound, Ostomy, and Continence Nursing
Joyce Pittman, Terrie Beeson, Colin Terry, Jill Dillon, Charity Hampton, Denise Kerley, Judith Mosier, Ellen Gumiela, Jessica Tucker
PURPOSE: Despite prevention strategies, hospital-acquired pressure ulcers (HAPUs) continue to occur in the acute care setting. The purpose of this study was to develop an operational definition of and an instrument for identifying avoidable/unavoidable HAPUs in the acute care setting. METHODS: The Indiana University Health Pressure Ulcer Prevention Inventory (PUPI) was developed and psychometric testing was performed. A retrospective pilot study of 31 adult hospitalized patients with an HAPU was conducted using the PUPI...
January 2016: Journal of Wound, Ostomy, and Continence Nursing
Merryn Gott, Tess Moeke-Maxwell, Lisa Williams, Stella Black, Gabriella Trussardi, Janine Wiles, Rangimarie Mules, Anna Rolleston, Ngaire Kerse
BACKGROUND: The number of people dying in advanced old age is increasing rapidly and building the evidence base regarding end - of - life care for older people has been identified as an international policy priority. The unique opportunity to link longitudinal studies of ageing with studies exploring the end of life circumstances of older people remains under-exploited internationally. Very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people, including Māori, at end - of - life and the needs of their whānau/ extended family carers...
2015: BMC Palliative Care
Chenjuan Ma, Shin Hye Park
PURPOSE: To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. DESIGN: A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States...
November 2015: Journal of Nursing Scholarship
William V Padula, Manish K Mishra, Mary Beth F Makic, Heidi L Wald, Jonathan D Campbell, Kavita V Nair, Robert J Valuck
OBJECTIVE: In 2008, the U.S. Centers for Medicare and Medicaid Services enacted a nonpayment policy for stage III and IV hospital-acquired pressure ulcers (HAPUs), which incentivized hospitals to improve prevention efforts. In response, hospitals looked for ways to support implementation of evidence-based practices for HAPU prevention, such as adoption of quality improvement (QI) interventions. The objective of this study was to quantify adoption patterns of QI interventions for supporting evidence-based practices for HAPU prevention...
December 2015: Worldviews on Evidence-based Nursing
Janet Stifter, Yingwei Yao, Muhammad Kamran Lodhi, Karen Dunn Lopez, Ashfaq Khokhar, Diana J Wilkie, Gail M Keenan
BACKGROUND: Little research demonstrating the association between nurse continuity and patient outcomes exists despite an intuitive belief that continuity makes a difference in care outcomes. OBJECTIVE: The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU). METHODS: A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study...
September 2015: Nursing Research
Ida Marie Bredesen, Karen Bjøro, Lena Gunningberg, Dag Hofoss
OBJECTIVES: To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. DESIGN: Multilevel approach to data from 2 cross-sectional studies. SETTINGS: 4 hospitals in Norway were studied. PARTICIPANTS: 1056 patients at 84 somatic wards. PRIMARY OUTCOME MEASURE: HAPU. RESULTS: Significant variance in the odds of HAPUs was found across wards...
2015: BMJ Open
Kimberly D Hall, Rebecca C Clark
Incontinence is a common problem among hospitalized patients and has been associated with multiple health complications, including incontinence-associated dermatitis (IAD) and hospital-acquired pressure ulcers (HAPUs). A prospective, descriptive study was conducted in 2 acute care neurology units to 1) assess the prevalence of incontinence and incidence of IAD and HAPUs among incontinent patients, and 2) evaluate the effect of caregiver education and use of a 1-step cleanser, moisturizer, barrier product on the development of IAD and HAPUs among patients with incontinence...
July 2015: Ostomy/wound Management
William V Padula, Mary Beth F Makic, Heidi L Wald, Jonathan D Campbell, Kavita V Nair, Manish K Mishra, Robert J Valuck
BACKGROUND: In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008. METHODS: In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States...
June 2015: Joint Commission Journal on Quality and Patient Safety
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