Was that pressure ulcer ‘present on admission?’

Pressure ulcers have been the focus of an increasing amount of attention over the past few years, appearing everyplace from the local evening news to the government’s list of potentially preventable conditions, where they can carry a pretty steep financial penalty. When I was in residency, for some reason, they just did not seem to be such a common or important issue ... or perhaps we just didn’t pay them their due respect.

These days, they command the attention of legislators, hospital administrators, and physicians alike, not just the attention of nurses and patients, as in days past. Not long ago, the July 2, 2013, issue of Annals of Internal Medicine devoted a significant portion of an issue to the topic of pressure ulcers.

While I already knew pressure ulcers are a significant cause of morbidity, and, infrequently, mortality, I was shocked to learn the extent of this condition – an estimated 1.3 to 3 million adults in this country are affected – and that the cost to treat a pressure ulcer ranges between $37,800 and $70,000 – yes, each! The yearly cost to the U.S. health care system may be as high as $11 billion! That’s a figure I would expect to see with diabetes complications or advanced heart disease.

The article, titled "Pressure Ulcer Treatment Strategies: A Systematic Comparative Effectiveness Review," summarized evidence comparing the efficacy and safety of various treatment strategies for adults with pressure ulcers. Researchers found that using air-fluidized beds, protein supplementation, electrical stimulation, and radiant heat dressings had moderate-strength evidence for healing (Ann. Intern. Med. 2013 July 2;159:39-50).

Pressure ulcer treatment and prevention are too frequently passed on to nursing staff, probably in part because physicians are busy addressing the primary cause for admission and in part because, quite frankly, the nursing staff treat the ulcers on a day-to-day basis and are more likely to have received an in-service educational session about various treatments, not to mention they are often more up-to-date on the latest formulary alternatives for treating various stages of skin breakdown.

But hospitalists should also have some skin in the game, pardon my pun.

There are simple things we can do to help the surveillance for decubitus ulcers, such as having patients turn on their sides when we listen to their lungs, instead if asking them to sit up in bed or listening anteriorly. That way we can take a quick glance at their bottoms when we auscultate their lungs. We can also reposition some patients ourselves when we see them lying in an awkward position. Asking them or their family members to take part in frequent repositioning is yet another simple task. 

With the profound impact pressure ulcers can have on quality of care, risk of complications, medical costs, and even length of stay, hospitalists are in a unique position to positively influence the rate of pressure ulcer formation by having a heightened sense of awareness of our individual patient’s risk and how we can best play a major role in preventing preventable skin breakdown.

 Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

Pressure ulcers have been the focus of an increasing amount of attention over the past few years, appearing everyplace from the local evening news to the government’s list of potentially preventable conditions, where they can carry a pretty steep financial penalty. When I was in residency, for some reason, they just did not seem to be such a common or important issue ... or perhaps we just didn’t pay them their due respect.

These days, they command the attention of legislators, hospital administrators, and physicians alike, not just the attention of nurses and patients, as in days past. Not long ago, the July 2, 2013, issue of Annals of Internal Medicine devoted a significant portion of an issue to the topic of pressure ulcers.

While I already knew pressure ulcers are a significant cause of morbidity, and, infrequently, mortality, I was shocked to learn the extent of this condition – an estimated 1.3 to 3 million adults in this country are affected – and that the cost to treat a pressure ulcer ranges between $37,800 and $70,000 – yes, each! The yearly cost to the U.S. health care system may be as high as $11 billion! That’s a figure I would expect to see with diabetes complications or advanced heart disease.

The article, titled "Pressure Ulcer Treatment Strategies: A Systematic Comparative Effectiveness Review," summarized evidence comparing the efficacy and safety of various treatment strategies for adults with pressure ulcers. Researchers found that using air-fluidized beds, protein supplementation, electrical stimulation, and radiant heat dressings had moderate-strength evidence for healing (Ann. Intern. Med. 2013 July 2;159:39-50).

Pressure ulcer treatment and prevention are too frequently passed on to nursing staff, probably in part because physicians are busy addressing the primary cause for admission and in part because, quite frankly, the nursing staff treat the ulcers on a day-to-day basis and are more likely to have received an in-service educational session about various treatments, not to mention they are often more up-to-date on the latest formulary alternatives for treating various stages of skin breakdown.

But hospitalists should also have some skin in the game, pardon my pun.

There are simple things we can do to help the surveillance for decubitus ulcers, such as having patients turn on their sides when we listen to their lungs, instead if asking them to sit up in bed or listening anteriorly. That way we can take a quick glance at their bottoms when we auscultate their lungs. We can also reposition some patients ourselves when we see them lying in an awkward position. Asking them or their family members to take part in frequent repositioning is yet another simple task. 

With the profound impact pressure ulcers can have on quality of care, risk of complications, medical costs, and even length of stay, hospitalists are in a unique position to positively influence the rate of pressure ulcer formation by having a heightened sense of awareness of our individual patient’s risk and how we can best play a major role in preventing preventable skin breakdown.

 Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

Pressure ulcers have been the focus of an increasing amount of attention over the past few years, appearing everyplace from the local evening news to the government’s list of potentially preventable conditions, where they can carry a pretty steep financial penalty. When I was in residency, for some reason, they just did not seem to be such a common or important issue ... or perhaps we just didn’t pay them their due respect.

These days, they command the attention of legislators, hospital administrators, and physicians alike, not just the attention of nurses and patients, as in days past. Not long ago, the July 2, 2013, issue of Annals of Internal Medicine devoted a significant portion of an issue to the topic of pressure ulcers.

While I already knew pressure ulcers are a significant cause of morbidity, and, infrequently, mortality, I was shocked to learn the extent of this condition – an estimated 1.3 to 3 million adults in this country are affected – and that the cost to treat a pressure ulcer ranges between $37,800 and $70,000 – yes, each! The yearly cost to the U.S. health care system may be as high as $11 billion! That’s a figure I would expect to see with diabetes complications or advanced heart disease.

The article, titled "Pressure Ulcer Treatment Strategies: A Systematic Comparative Effectiveness Review," summarized evidence comparing the efficacy and safety of various treatment strategies for adults with pressure ulcers. Researchers found that using air-fluidized beds, protein supplementation, electrical stimulation, and radiant heat dressings had moderate-strength evidence for healing (Ann. Intern. Med. 2013 July 2;159:39-50).

Pressure ulcer treatment and prevention are too frequently passed on to nursing staff, probably in part because physicians are busy addressing the primary cause for admission and in part because, quite frankly, the nursing staff treat the ulcers on a day-to-day basis and are more likely to have received an in-service educational session about various treatments, not to mention they are often more up-to-date on the latest formulary alternatives for treating various stages of skin breakdown.

But hospitalists should also have some skin in the game, pardon my pun.

There are simple things we can do to help the surveillance for decubitus ulcers, such as having patients turn on their sides when we listen to their lungs, instead if asking them to sit up in bed or listening anteriorly. That way we can take a quick glance at their bottoms when we auscultate their lungs. We can also reposition some patients ourselves when we see them lying in an awkward position. Asking them or their family members to take part in frequent repositioning is yet another simple task. 

With the profound impact pressure ulcers can have on quality of care, risk of complications, medical costs, and even length of stay, hospitalists are in a unique position to positively influence the rate of pressure ulcer formation by having a heightened sense of awareness of our individual patient’s risk and how we can best play a major role in preventing preventable skin breakdown.

 Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.