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Lee Squitieri, Daniel A Waxman, Carol M Mangione, Debra Saliba, Clifford Y Ko, Jack Needleman, David A Ganz
OBJECTIVES: To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. DATA SOURCES/STUDY SETTING: Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). STUDY DESIGN: Retrospective cross-sectional study. DATA COLLECTION/EXTRACTION METHODS: We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011...
January 25, 2018: Health Services Research
Kerri Elsabrout, Eleanor Orbacz, Leigh Anne McMahon, Susan Apold
BACKGROUND: Identifying strategies to protect patients most at risk for hospital-acquired pressure ulcers (HAPU) is essential. HAPUs have significant impact on patients and their families and have profound cost and reimbursement implications. AIMS: This article describes the successful implementation of a hospital-wide mattress switch-out program using a Multidisciplinary Task Force, which resulted in a decrease in HAPUs and significant cost savings. RESULTS: As a result of this quality improvement project supported by evidence, the hospital realized a 66...
March 8, 2018: Worldviews on Evidence-based Nursing
Suzanne E Courtwright, Kari A Mastro, Christa Preuster, Navid Dardashti, Sandra McGill, Myrlene Madelon, Donna Johnson
PURPOSE: This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population. DESIGN AND METHODS: An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
September 8, 2017: Journal for Specialists in Pediatric Nursing: JSPN
Holly Kirkland-Kyhn, Oleg Teleten, Machelle Wilson
Deep tissue injury (DTI) may develop in critically ill patients despite implementation of preventive interventions. A retrospective, descriptive study was conducted in a 620-bed, level 1 trauma, academic medical center with 7 adult intensive care units ([ICUs] cardiac surgery, trauma surgery, burn surgery, med-surgery, neurosurgery, medical, and transfer) among patients treated from January 1, 2010 to January 1, 2015. All patients 18 years of age or older that developed a sacral DTI that evolved into a Stage 3, Stage 4, or unstageable hospital-acquired pressure ulcers (HAPU) in the ICU were included...
February 2017: Ostomy/wound Management
Lisa Zubkoff, Julia Neily, Beth J King, Mary Ellen Dellefield, Sarah Krein, Yinong Young-Xu, Shoshana Boar, Peter D Mills
BACKGROUND: In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs). METHODS: During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims...
November 2016: Joint Commission Journal on Quality and Patient Safety
Kimberly D Hall, Rebecca C Clark
Patients in critical care areas are at risk for developing hospital-acquired pressure ulcers (HAPUs) due to their physical conditions and limited ability to reposition themselves. A prospective, 2-phase quality improvement study was conducted from September to November 2011 and from February to April 2012 in 1 medical and 1 surgical ICU to investigate the impact of a turn-and-assist device on the incidence of HAPUs and the time and personnel required to reposition patients reported as person/minutes (staff x minutes)...
November 2016: Ostomy/wound Management
Peggy Kalowes, Valerie Messina, Melanie Li
BACKGROUND: In critically ill patients, prevention of pressure ulcers is a challenge because of the high risk for multiple comorbid conditions, immobility, hemodynamic instability, and increased use of medical devices. OBJECTIVES: To compare the difference in incidence rates of hospital-acquired pressure ulcers (HAPUs) in critically ill patients between those treated with usual preventive care and a 5-layered soft silicone foam dressing versus a control group receiving usual care...
November 2016: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
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: Nursing 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...
September 2017: 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...
April 1, 2017: 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...
April 6, 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
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