Antisepticos

Joan Wurster

What Role Can Nurse Leaders Play in Reducing the Incidence Of Pressure Sores?
Executive Summary
Pressure sores have plagued the nursing profession for many years as a major health care problem in terms of a patient’s suffering and financial cost. Pressure sores are increasingly common in hospitalized patients in the United States with a 63% increase from 1993 to 2003. The nurseleader is accountable for the occurrence of pressure sores, a nurse-sensitive indicator, by a scorecard which is benchmarked against other facilities. The nurse leader must take a systematic approach in the prevention of pressure sores, with the strategy being consistent and motivating to the staff in order to improve patient outcome. The chief nursing officer, the unit manager, and the bedsidenurse must all collaborate to prevent tissue injury in patients at risk for developing pressure sores and to promote wound healing in patients with existing breakdown.

P

RESSURE SORES HAVE PLAGUED

the nursing profession for many years as a major health care problem in terms of a patient’s suffering and financial cost. A hallmark of quality nursing care is excellent skin care. Hospitalsevaluate themselves based on the prevalence of skin breakdown (Suddaby, 2006). In the United States, approximately one million people are affected by pressure sores, with a cost of $1.6 billion annually. Stage 1, 2, and 3 pressure sores cost an estimated $2,000 to $30,000 per hospital stay, while a stage 4 pressure sore is estimated as high as $70,000 (Moody, Gonzales, & Cureton, 2004). With anincreasing demand for proof of quality patient care from legislators, payers, business leaders, and the public, the American Nurses Association (ANA) responded, in 1995, with the Safety and Quality Initiative. This resulted in the development of a national nursing database measuring the impact of nursing care and patient outcomes, driven by data and evidence-based practice, a standard toward which,Medicare and the Joint Commission on Accreditation of Healthcare Organizations are gravitating. Medicare developed a program, pay-for-performance (P4P),

designed to reward providers for improving quality of care and exceeding specific benchmarks in regards to pressure sores using a national quality database known as the National Database of Nursing Quality Indicators (NDNQI) (Haberfelde, Bedecarre,& Buffum, 2005). The NDNQI is a proprietary database of the ANA. Data are collected and evaluated on unit-specific nurse-sensitive indicators from hospitals throughout the United States. Quarterly reports contain charts and maps comparing hospital unit averages with national averages. These reports enable hospitals to benchmark one institution against another. Pressure sores are used as anurse-sensitive indicator because it is believed that the greater quality and quantity of nursing care, the greater the patient outcome.

Common Risk Factors
Pressure sores are increasingly common in hospitalized patients in the United States with a 63% increase from 1993 to 2003; the mean length of stay specifically for pressures sores was 13 days, with a cost

JOAN WURSTER, MSN, RN, is TraumaClinic Manager, St. Mary’s Trauma Center, West Palm Beach, FL.

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of approximately $38,000 (Russo & Elixhauser, 2006). Early intervention is the key to the prevention of pressure sore development. Nurses must be educated and aware of the signs of tissue breakdown and factors that place patients at risk. Although there are more than 100risk factors identified in the literature (Lyder, 2003), six of the most common risk factors will be discussed. 1. Reduced mobility is the most important element in the breakdown of tissue and the development of pressure sores (Clay, 2000). Tissue necrosis develops when soft tissue is compressed, usually between an external surface and a bony prominence for a prolonged period of time. Immobility...