Innovative Strategies to Confront the Challenges of Reducing Pressure Ulcers

The NYC Health & Hospitals Corporation (HHC) is a public health corporation with 11 acute care, 4 long term care, 6 diagnostic and treatment centers, a health and home care agency and a managed care agency. HHC provides health care services to a large, economically disadvantaged, multicultural and multiethnic population with variety of chronic diseases and little attention to preventive care. It is estimated the cost of treating pressure ulcers is as much as $20 billion annually. Approximately, 60,000 deaths per year are related to pressure ulcers. While pressure ulcers have been considered an unavoidable complication of severe illness, studies indicate that most ulcers are preventable.

A Pressure Ulcer Task Force, composed of nurses, nurse practitioners, physicians, dieticians, pharmacists and physical therapists from the 4 long term and 11 acute care facilities was formed to identify preventative measures, improving care and outcome of pressure ulcers. A HHC Corporate-wide Pressure Ulcer Guideline was developed by the Task Force to standardize Quality Improvement measurement processes and methodologies and implement corporate-wide best practice guidelines. Members were divided into four consulting interdisciplinary teams, each of which acted as an expert source of information for its institutions but also adopted four other HHC institutions to promote best practice interventions through the Pressure Ulcer Guideline, educating staff through conferences and bedside rounds of challenging cases, to review procedures and provide advise, and to collaboratively support the efforts of the peer task members from the adopted institution. Communication and support from peer members bolstered individual confidence and enthusiasm. The formation of individual teams further empowered the task members as educators and consultants who were eager to guide other institutions and to serve as models for their own facilities. The task force created an essential formulary of pharmaceutical products, supplies, and equipment intended to reduce ulcer risks, accelerate wound healing and provide more cost effective care. It prepared an assessment and treatment form that effectively improved healing rates. Mandatory documentation of pressure ulcer risk or the presence of pressure ulcers in the physician admission note leading to a computerized set of orders for monitoring risk factors and instituting appropriate therapy enhances the physician responsibilities in prevention and treatment of skin ulcers.