Background and Implications Personal and Social Costs

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Background and Implications Personal and
Social Costs
Pressure Ulcer Prevention Summit Minnesotas
Response to Adverse Health Events

• Ruth A. Bryant RN, MS, CWOCN
• Director, webWOC Nursing Education Program
• Minneapolis, MN

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How Big is the Problem?

• 1.7 million patients develop each year
• 1.5-3 million adults with PU in United States
• 2.2 to 3.6 billion dollars are spent annually for
  the care of pressure ulcers.
• Mean additional cost per patient with new
  pressure ulcer 14,260
• 13-56 recurrence rate

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How A Pressure Ulcer Develops

• Localized area of tissue destruction
• Caused by compression of soft tissue over bony
  prominence and external surface for prolonged
  period for time

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Pressure Ulcer Stages
Limited to Epidermis skin intact
Does not extend below Dermis
Extends into Muscle, Tendon, or Bone
Involves Subcutaneous Tissue
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How Common is the Problem?

• Prevalence (pre-existing)
• Acute care 10.1 to 17
• Long-term 2.3 to 28
• Home care 0 to 29

• Incidence (nosocomial)
• Acute care 0.4 to 38
• Long-term 2.2 to 23.9
• Home care 0 to 17

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Can develop within 24 hours of insult or take as
long as 5 days to present
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Unable to stage

• Normal tissue architecture not visible in base of
  wound
• Nonviable tissue present (eschar or slough)

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Deep Tissue Injury (DTI)

• A pressure-related injury to subcutaneous tissues
  under intact skin.
• Initial appearance of a deep bruise.
• Purple pressure ulcer, blister or bruise
• Herald the subsequent development of a Stage
  III-IV pressure ulcer even with optimal
  treatment.

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So What Happens Next?
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Case Study Karen

• young mother of two
• face crushed when she was a child
• Numerous fascial reconstructive surgeries
• PU developed after long surgical procedure as a
  teen
• my biggest complaint was the pain in my heel.

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Karens story

• 8 years later I still have problems with my heel
  ... I cant run after my children like other
  mothers, and I would love to buy fun sandals in
  the summer, but I cant.

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Vulnerable Patient Populations

• Usual Risk Factors
• Mobility
• Activity
• Nutrition
• Moisture

• Medical Conditions
• Diabetes
• Edema
• Impaired Tissue Perfusion (lung dx, heart dx, PVD)

• Surgical patients
• Incidence 4 to 45
• CV procedures
• Ortho procedures
• Heels, coccyx, head

• Pediatric populations
• Incidence 8 to 15
• Prevalence 0.5 to 27
• Age 6 months to 17 y/o
• Occiput

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Case StudyClayton

• Heart transplant at 13 y/o
• Placed on support surface
• Developed eschar covered pressure ulcer on
  occiput after 10 hour surgery and 2 days of
  sedation.
• Now has bald spot.

Just one more scar
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Clays story

• Clays nurse was an excellent critical care
  nurse ... very on top of Clays numbers and
  medications. There just wasnt much attention
  paid to his skin.
• Sonja, Clays mother

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PU Care Requires Intense use of Resources

• Topical dressings
• Dressing changes
• Nursing care
• Physical therapy
• Medications
• Nutritional support

• Extended length of stay
• Extra clinic visits
• Increased risk for complications
• Additional surgery

Prevention Interventions 130 in 1995 to 158
in 1997
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Besides monetary costs

• Emotional upheaval
• Pain
• Disfigurement
• Loss of productive time
• Delay in return to routine
• Prolonged role as a patient
• Modified clothes and shoes

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How long does it take a pressure ulcer to heal?

• 2-4 weeks
• 6-8 weeks
• 3-6 months
• 6-9 months

• Consider who is at risk for Pressure Ulcers.
• Consider wound healing building blocks protein,
  vitamins, oxygen, proper mix of growth factors,
  functioning leukocytes

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• Terminology Traps
• Unavoidable PU
• Downstaging
• Reverse Staging

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Case Study Mr. Rynearson

• 90 y/o
• Raised 5 children
• Lived independently
• Diagnosed with metastatic prostate cancer
• Within 4 days of admission to nursing home, fell
  and developed Pressure Ulcer on coccyx

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A reduced quality of life ...

• He had a smile on his face, but when he moved,
  the pain from the pressure ulcer would make him
  wince. I realized then how much it had reduced
  the quality of his life during his final days.
• Deb Perry, R.N.,
• Mr. Rynearsons daughter

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The Personal Cost of aPressure Ulcer?
More than anyone can calculate. More than
anyone should have to bear.
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Background and Implications Personal and
Social Costs
Pressure Ulcer Prevention Summit Minnesotas
Response to Adverse Health Events

• Ruth A. Bryant RN, MS, CWOCN
• Director, webWOC Nursing Education Program
• Minneapolis, MN

23
References

• Bryant RA and Nix DH Acute and Chronic Wound
  Management, Mosby, St. Louis, in press, April,
  2006
• Langemo DK, Melland H, Hanson D, Olson B, Hunter
  S The lived experience of having a pressure
  ulcer A qualitative analysis, Adv Skin Wound
  Care 13225, 2000
• Lyder CH, Preston J, Grady JN, Scinto J, Allman
  R, Bergstrom N, Rodeheaver G Quality of care for
  hospitalized medicare patients at risk for
  pressure ulcers, Arch Intern Med 1611549, 2001.
• Popescu A Salcido RS Wound pain a challenge
  for the patient and the wound care specialist.
  Adv Wound Care, 17(1)14-20, 2004.
• Rintala DH Quality of life considerations, Adv
  Wound Care 8(4)28, 1995.
• Szor JK, Bourguignon C. Description of pressure
  ulcer pain at rest and at dressing change. J
  Wound Ostomy Continence Nurs. 26(3)115-20, 1999.
• Wound, Ostomy, and Continence Nurses Society.
  Guideline for prevention and management of
  pressure ulcers.Glenview, IL WOCN, 2003.