Pressure sores, or more commonly known as bed sores, pressure ulcers, or decubitus ulcers, are among the top priorities of both national and local senior health advisory panels. In fact, the Centers for Medicare and Medicaid Services (CMS) has listed reducing pressure sores as a primary goal in the 2016 to 2017 campaigns for better senior health. And, this campaign is evolving, including the finalization of rules to take effect regarding tracking requirements and possible financial repercussions due to pressure sores.
The New Guidelines for Pressure Sores Take Effect in One Year
Many health care facilities, especially nursing homes and long-term acute care hospitals, have already taken steps to implement tracking and monitoring of pressure sores as part of the IMPACT Act of 2014. However, inconsistencies in the documentation of existing or worsening pressure sores have led the changes.
According to the National Pressure Ulcer Advisory Panel (NPUAP), starting October 2017, the term, “pressure sore,” will be replaced with, “pressure injury.” Yet, another guideline has been overlooked by much of the media. All health care facilities will see a continued one percent penalty if the prevalence of pressure sores continues within a given facility and falls into the lowest quartile nationally. But, this is a minor change compared to the CMS’ new rules.
CMS mandates all health facilities, including short-term and long-term facilities, track and report pressure sores “that were not present or were at a lesser stage on admission.” The financial penalties for failure to inhibit the worsening or development of pressure sores are set to begin in 2018, reflecting one year for facilities to begin tracking and implement reporting requirements.
Why Were the New Rules Developed?
The new rules aim to reduce misconceptions and minimalist perception of pressure sores among today’s seniors. Pressure sores are a “serious health concern", but some believe pressure sores are inevitable. This is simply untrue. According to Healthline, a pressure sore develops when pressure points inhibit the flow of blood and oxygen to a given part of the body.
For example, a healthy person who spends a long time lying in bed may often turn to relieve the buildup of pressure. But, if this example is applied to a person with health problems that inhibit mobility or strength, such as a stroke or paralysis, he or she may spend vast amounts of time in the same position every day. As a result, the only way to eliminate the possibility of developing pressure sores is to relieve the pressure often.
Seniors are often thought of as set in their ways, and some may refuse repositioning or range of motion exercises. While this is their right, it increases the risk of developing pressure sores. In senior care facilities, large senior-to-caregiver ratios may leave staff members willing to accept the first refusal as the final response. But, the new guidelines will make it ideal for staff members to encourage repositioning or movement repeatedly.
Unfortunately, no discussion on preventing pressure sores is complete without touching on caregiver responsibilities. There are cases, although exact statistics are not reported, where caregivers may willingly leave a senior in one position beyond reasonable expectations. All immobile seniors, especially those who cannot reposition themselves, should be repositioned in their bed at least every two hours. Yet, pressure sores may also develop from spending hours and hours in wheelchairs throughout the day.
Ultimately, movement and encouraging staff members to work with seniors are the best ways to reduce constant pressure on the buttocks, legs, ankles, and other areas of the body continually in contact with a firm surface, such as bedding. Of course, ensuring skin is kept clean and dry will reduce risk as well.
The new rules are designed to force senior caregivers and senior care facilities to be more vigilant and cautious with how pressure sores are monitored and tracked.
What Do the New Rules Mean to You?
With less than one year from the implementation date for the first part of the new rules regarding pressure sores, it is easy to feel overwhelmed. But, you need to take a few actions to start preparing for their implementation.
1. Audit the health records, specifically wound treatments and documents, of those cared for in your facility. Look for the initial dates of identified pressure sores, and determine which pressure sores grew worse or became evident while a senior was in your facility.
2. Does your facility have a pressure sore log? If not, you need to create a way of tracking pressure sores outside of specific health records of your clients. This provides a fast way of reviewing current pressure sore rates.
3. Review pressure sore prevention guidelines with all senior caregivers. This step is essential to keeping everyone on track with reducing the prevalence of “bed sores.”
4. Identify seniors at greatest risk for developing pressure sores. Knowing who is likely to develop pressure sores is the most proactive way to prevent them. You may consider increasing activity participation or creating in-room “reminders to reposition” affected seniors.
5. Provide training on the importance of perineal care. Urine, bowel movement, and sweat decrease skin integrity when left in contact with it for an extended period. Ensure all staff members understand that checking for incontinence means checking more than every two hours. Although this is standard practice, people do go to the restroom more often, especially with age.
6. Repeat all steps every other month indefinitely. The savings found from preventing just one pressure sore could easily pay for any training or extra time required in completing these steps.
Imagine what it is like to live with a sore on your body that only get worse. Now, imagine what it is like if you cannot move or readjust yourself to relieve the pressure. For seniors living with pressure sores, the pain can be unbearable, and the health effects of pressure sores can be life-threatening.
New rules have been created to make preventing pressure sores an urgent concern for seniors, and you need to understand how they will affect your organization. If you fail to take any of these actions, including failure to document new or worsening pressure sores, you will see a reduction in Medicare payments starting in October 2018. Or worse, a senior in your care could lose his or her life due to severe pressure sores.