Proper management of wounds and incontinence is critical to resident health, to be sure, but it can also have a significant impact on your facility's reputation and bottom line. Wounds and incontinence detract from a facility's quality reputation, can result in lawsuits and put a strain on nursing resources.

SCOPE OF THE ISSUE
According to a recent study on long-term care liability for pressure ulcers in the Journal of the American Geriatrics Society, 20 percent of residents will develop at least one pressure ulcer within two years of admission to long-term care.¹ The National Pressure Ulcer Long-Term Care Study found that rates were even higher than those previously reported, with 29 percent of all monitored residents developing a pressure ulcer during a 12-week observation period.²

Urinary incontinence is a stigmatized, underreported, under-diagnosed, under-treated condition that is erroneously thought to be a normal part of aging.³ More than half of all residents in nursing homes are incontinent.⁴ Mismanagement of incontinence can lead to skin breakdown and pressure ulcer development. The combination of frail tissue, chronic conditions and immobility make skin care a priority for long-term care residents.

FINANCIAL IMPACT
The financial stakes are high when you combine residents' underlying debilities with a reimbursement system that bundles routine, ancillary and capital costs into one prospective payment and withholds reimbursement for pressure ulcers that are acquired in the facility.⁵

 The annual cost of treating pressure ulcers for a 100-bed facility can average $300,000,² with the overall cost to treat across care settings ranging from $4,000 to $40,000 per ulcer.⁶ 

Data from an article published in the Journal of the American Geriatrics Society showed that lawsuits related to pressure ulcers are increasingly common and costly. Residents realized some type of recovery against the facility in 87 percent of the cases (verdicts for the resident plus settlements), and were awarded amounts as high as $312 million in damages.⁵

But a comprehensive pressure ulcer prevention program can be a cost effective way to improve clinical outcomes, especially when prevention and treatment methods are appropriately matched to patient needs.⁷

The efficacy and cost-effectiveness of an in-house interdisciplinary wound and skin care team has been clearly documented.^7,8

DEVELOPING PROGRAMS
Skin management programs can improve resident care, minimize liability and pay for themselves in a short period of time. To develop a successful skin care management and pressure ulcer prevention program, use a multidisciplinary approach that includes physicians, nursing, physical therapy, dietary, pharmacy, occupational therapy and others. Each of these team members can affect the development and healing of pressure ulcers.

The National Pressure Ulcer Long-Term Care Study identified key risk factors for developing pressure ulcers. The use of catheters and positioning devices were associated with an increased likelihood of developing pressure ulcers.² On the other side, nutritional intervention, use of disposable briefs and increased nursing and aide hours per patient were all associated with a decreased likelihood of developing pressure ulcers.²

While these are not the only factors, they can definitely be influenced by your approach to staffing and diligent skin care management programs.

MEASURING SUCCESS
Once you've implemented a skin care management program, establish a baseline for skin breakdown/pressure ulcer incidence, and then measure these rates every 10 to 14 days for changes associated with your interventions. If you're not getting the results you want, make adjustments. While there are some established interventions that have been proven effective, each facility must be able to address root cause issues based on individual assessments.

The first and last step in implementing a wound and incontinence program that supports your bottom line is to view it as an investment, rather than an expense. Evaluate, invest, monitor and measure. Continue to evaluate and recalibrate as needed. By doing so, you'll provide better care, protect your reputation and manage your costs.

 References

1. Voss AC, Bender SA, Ferguson ML, Sauer AC, Bennett RG, Hahn PW. Long-term care liability for pressure ulcers. J Am Geriatr Soc 2005;53(9):1587-92.  
2. Horn SD, Bender SA, Ferguson ML et al. The National Pressure Ulcer Long-Term Care Study: pressure ulcer development in long-term care residents. J Am Geriatr Soc 2004;52(3):359-67.
3. Levy R & Muller N. Urinary incontinence: Economic burden and new choices in pharmaceutical treatment. Advances in Therapy 2006;23(4): 556-573.
4. Bell M, DeMarinis M. The psychological cost of incontinence. ECPN. 2006;109:13-14.
5. Skilled Nursing Facilities PPS. Center for Medicare & Medicaid Services. Apr. 6. 2009. Retrieved from www.cms.hhs.gov/SNFPPS/  on Sept. 21, 2009.
6. Agostini JV, Baker DI, Bogardus ST. Prevention of Pressure Ulcers in Older Patients. Agency for Healthcare Research and Quality; Jul 1, 2001. Report No. 43.
7. Xakellis GC, Jr., Frantz RA, Lewis A, Harvey P. Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care. Adv Wound Care 1998;11(1):22-9.
8. Kerstein MD, Gemmen E, van Rijswijk L et al. Cost and cost effectiveness of venous and pressure ulcer protocols of care. Dis Manage Health Outcomes 2001;9(11):651-63.

  Stacey Scoggin Pugh is senior director, global clinical development for Kinetic Concepts Inc. DISCLOSURE: KCI provides therapies and products for the wound care, tissue regeneration and therapeutic support system markets.