Pressure ulcers, commonly referred to as “bed sores”, are a growing problem among elderly and immobile patients, according to a study by the University of Michigan. According to the study, the amount of pressure ulcers may be up to ten times as common as the Medicare program reports.
The different rates proffered by Medicare and the University of Michigan study derive from the different methods used to detect pressure ulcers. Medicare uses billing data – which is sourced from an administrative team interpreting notes on medical records left by doctors and nurses. Because hospitals receive financial penalties for a higher number of pressure ulcers, there is an incentive for hospital administrations to downplay the number of sores within their hospitals.
The University of Michigan study, however, compared the data given by the hospital administration to “surveillance data” – basically, monitoring the skin assessments given by nurses at hospitals. This data showed that pressure ulcers were up to 10 times more common than the “administrative data” offered by Medicare suggests. According to Jennifer Meddings, M.D., M.Sc. and assistant professor in the Department of Internal Medicine, this information shows the need for a standardized approach to diagnosing bedsores – so the data provided is both accurate and uniform across hospitals.
At the same time, hospitals are not always dealing with pressure ulcers in a medically appropriate fashion. In a recent case out of Alabama, an Alabama nursing home was found liable for $135,000 in damages resulting from inappropriately handling of a patient’s pressure ulcer.
According to the Court, the nurses and doctors at Bibbs Medical Center Nursing Home in Centreville, AL ignored a patient’s pressure ulcer on her feet for a staggering 38 days during the autumn of 2010. The Court fined the facility $3,550 per day for its non-compliance – stating that the blatant disregard for Medicare and Medicaid Services regulations put the patient in “immediate jeopardy” – meaning that the noncompliance caused the patient “serious harm, impairment or death to a resident.” Bibbs Medical Center appealed, but the Court of Appeals affirmed the lower court ruling.
According to the Center for Medicare and Medicaid Survey, there are several ways that a facility can avoid legal liability for pressure ulcers. First, a facility must ensure that any resident that enters the facility without pressure sores does not later develop them (unless the patient’s medical condition demonstrates that a pressure ulcer was unavoidable.) Second, a facility must ensure that any patient that has pressure sores receives prompt and necessary treatment – especially to ensure that no further infection or pressure ulcer develops.
According to the CMS, the best way to prevent pressure ulcers is to: First, have an appropriate treatment policy in place at the facility. Next, ensure health professionals are properly trained in these procedures. Third, provide current medical information on pressure ulcers to health professionals, patients, and their families. Finally, provide support surfaces that reduce the likelihood of pressure ulcers.