By Glenda Motta RN, MPH
Identifying Areas for Improvement
Medicare uses payment incentives to induce quality improvement in hospitals and skilled nursing facilities. Patient Safety Indictors (PSIs) are one example of these incentives. PSIs are defined as: the incidence of potentially preventable, adverse events resulting from inpatient care. The most common adverse event reported by CMS in 2007 was “decubitus ulcers.”
The commonality of these reports, coupled with the fact that the incidence (the number of patients who develop a pressure ulcer after admission to a hospital) remained steady at approximately 7.6%, calls into question the effectiveness of support surfaces currently in use.
In today’s tough reimbursement climate, the ideal support surface will address as many known risk factors as possible. Unfortunately, healthcare professionals and purchasing agents continue to select support surfaces based on cost or studies that primarily address interface pressure readings.
Instead, a product evaluation should, at a minimum, examine the ability of the surface to address:
- Pressure redistribution
- Shear forces
- Ulcers on multiple turning surfaces
- Ease of patient repositioning
- Impact on functional mobility/ease of transfer
Correlating the interface pressure measured for various support surfaces with relevant prevalence or incidence information is critical to evaluate the potential effectiveness of a product.
Clinicians and purchasing agents should demand to review incidence data correlated to interface pressure measures for any support surface considered for purchase. The value analysis can then include potential savings based on quality improvement.
Finally, clinicians and purchasing agents should expect the supplier to provide a multi-phased evaluation of the support surface technology under consideration. For example, this would include:
- A pre-clinical analysis comparing the product to other surfaces, using total body pressure mapping of human subjects in supine position and interface pressures measured on high-risk areas;
- An evaluation measuring pressure on the left trochanter in healthy volunteers;
- The measurement of pinch shear forces on the occiput and heels using pressure mapping;
- Evidence that the surface can provide a high level of envelopment;
- Clinical evaluations conducted in the acute care hospital and skill nursing facility, demonstrating positive outcomes, such as zero incidence of new pressure ulcers ad improvement in existing wounds;
- Data demonstrating improved functional mobility for patients places on the surface, supporting physical therapy goals and maximum rehabilitation needed for early discharge.
Sources: Medpac. Report to the Congress: Medicare payment policy. Mar 2009
About The Author
Glenda Motta RN, MPH is a reimbursement consultant and wound care expert, publishing over 125 articles and books, serving as the President of the WOCN (1987-1989), and founding GM Associates, Inc., a healthcare marketing and reimbursement firm.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.