New Pressure Ulcer Chapter in the Geriatrics Review Syllabus
The Geriatrics Review Syllabus, 9th Edition, also known as GRS9, has been released and I am thrilled to be author of the newly revised and expanded chapter on Pressure Ulcers. The GRS9 is a comprehensive reference on geriatric medicine, a study guide for those preparing to take board examinations, and a teaching resource for residents, students, and other trainees. GRS9 is updated every three years, …Read More
Pressure Ulcers are an Under-Appreciated Public Health Issue
As a geriatric fellow back in the 1980’s I became intrigued by the wide prevalence of pressure ulcers and how little literature there was on this disease. Three decades later, they have not gone away and it amazes me that they are not on the list of recognized public health threats. According to the Agency for Healthcare Quality and Research, pressure ulcers affect up …Read More
Infections Related to Pressure Ulcers are Always Serious
Infections related to pressure ulcers are always serious events because most patients with these wounds are already compromised, and open wounds provide a portal for pathogenic bacteria to enter the body. Reasons for compromise include immobility, neurologic impairment and acute or chronic organ system disease. Begin with a compromised patient, then add an infected pressure ulcer, and you have a serious medical situation that requires immediate attention. Factors that favor …Read More
The Geriatric Workforce and Quality of Care
What could be less intuitive than a shrinking medical specialty in the face of surging demand? A recent New York Times article discussed the growing shortage of geriatricians in America. Despite the fact that there are more older Americans than any time in history, there are only about 7,000 geriatricians in practice in the United States. The article points out that the field is becoming even …Read More
Body Casts in WWII: A Historical Perspective on Medical Device Related Pressure Ulcers
Surgeons and medics apply a plaster-of-paris body cast on an injured soldier. Photo courtesy of the New York Public Library. During WWII, the incidence of pressure ulcers in young injured soldiers increased as a result of plaster body casts and immobilization splints – an early example of medical device related pressure ulceration. Plaster-of-paris has been used for centuries to treat fractures by immobilizing bones and allowing undisturbed …Read More
Historical Roots of the “Avoidable-Unavoidable” Pressure Ulcer Controversy
This post gives another preview of what I will be covering in my upcoming webinar entitled History of Pressure Ulcers & Wound Care: Past, Present, & Future, sponsored by the National Pressure Ulcer Advisory Panel. Some years ago while browsing in an antiquarian bookstore I opened a volume entitled Lectures on the Diseases of the Central Nervous System by Jean Martin Charcot published in 1877. Among …Read More
Upcoming Webinar on History of Pressure Ulcers & Wound Care
I am thrilled to announce that registration is now open for my webinar entitled History of Pressure Ulcers and Wound Care: Past, Present and Future, sponsored by the National Pressure Ulcer Advisory Panel (NPUAP). This event takes place on November 19th at 1:00 PM EST, and coincides with World Wide Pressure Ulcer Prevention Day 2015. My discussion covers such topics as wound care in Ancient …Read More
Government Data Sheds Doubt Upon Pressure Ulcers as a Quality Indicator
Nearly all organizations concerned with healthcare quality have recognized pressure ulcers as a quality indicator. This assumption has impacted reimbursement policy and facility ratings, and resulted a risk-management burden for caregivers across the healthcare continuum. Despite the fact that pressure ulcers can sometimes reflect upon quality of care, it is increasingly recognized that many pressure ulcers are unavoidable. A new analysis of data collected by the Office of …Read More
New Government Report on Dying in America has Implications for Wound Care
A recently released report on Dying in America has important implications for the standard of care for persons with chronic wounds who are approaching life’s end. It was published by the prestigious Institute of Medicine and written by a panel of recognized experts on the topic of end-of-life care. The Institute is the health arm of the National Academy of Sciences and acts under a …Read More
Pressure Ulcer Care in Hospitals: What We Can Learn from the Texas Ebola Debacle
A simple lapse in communication in a Texas hospital resulted in a patient with a deadly contagious disease being discharged home. The information regarding the patient’s travel history was recorded into the electronic medical record (EMR) by a nurse but not transmitted to the doctor who made the decision to discharge him. Such an error seems difficult to comprehend, but this type of communication mishap …Read More
The Old Man of the Lake on the Cover of The Gerontologist
In 2010 the closing of St. Vincents Hospital in Manhattan gifted me with time to indulge my wanderlust, and so I went to Lake Titicaca in the Bolivian highlands of South America to celebrate the winter solstice with the shamans. The Gerontologist just published a cover photo from that trip, and here is the story of the image that features an ancient ceramic portrait of …Read More
Pressure Ulcer as “Never Event”: Fact or Myth?
The term “never event” is commonly applied to pressure ulcers, giving the impression that they are always associated with medical error. As such, it lends this outcome an emotional charge that can lead to misplaced patient dissatisfaction and unnecessary accusations of wrongdoing or poor quality. Although pressure ulcers are sometimes associated with factors such as inadequate staffing and nutritional care, the preventability of all pressure …Read More
Wound Healing in the Geriatric Patient
I recently served as guest editor of a special issue on aging for Today’s Wound Clinic, a magazine devoted to contemporary approaches to wound clinic management. This special issue on the geriatric patient was published in November/December 2013, Volume 7, Issue 9. Please take a look at the links below to the articles. The following paragraphs are reprinted from my editorial. I developed an interest …Read More
Palliative Care for Non-Healing Pressure Ulcers
There is a saying that time heals all wounds, but this is not always the case for pressure ulcers. Those of us who care for patients with pressure ulcers know that some wounds will not heal, and cure becomes an unrealistic goal. Partnering with the patient and family to take a palliative care approach rather than an aggressive plan for healing can potentially reduce suffering, …Read More
Pressure Ulcer Guide Helps New Jersey Nursing Homes
In an unusual agreement between the New Jersey Hospital Association, the Centers for Medicare and Medicaid Services (CMS), and the New Jersey Department of Health, the Pocket Guide to Pressure Ulcers authored by myself and Elizabeth Ayello PhD, RN will be distributed to skilled nursing facilities across the state of New Jersey. Money collected through Civil Monetary Penalties for survey deficiencies will pay for purchase …Read More
New Research Sheds Light on Hospital Acquired Pressure Ulcers
A new study published in the Journal of the American Geriatrics Society sheds light on hospital acquired pressure ulcers with data on epidemiology, mortality, and patient characteristics. Its results are certain to fuel the debate on avoidability of pressure ulcers. The researchers analyzed 51,842 discharges of hospitalized Medicare patients in 2006 and 2007 for occurrence of hospital acquired pressure ulcers (HAPU). They found a nationwide HAPU prevalence …Read More
Pressure Ulcer Nomenclature and Documentation
Flawed and inconsistent wound documentation has serious risk-management implications. This blog post will examine some fine points regarding pressure ulcer nomenclature and documentation. Many definitions and classification schemes for pressure ulcers were developed over the years and continue to be a source of confusion. As patients move across the healthcare continuum from hospital to rehabilitation facility to nursing home, descriptive data can vary greatly even if …Read More
Pressure Ulcer Prevention for Patients in Wheelchairs
In most cases pressure ulcer prevention can be accomplished by risk assessment followed by common sense choices for pressure reduction. In these days of evidence based medicine, health care providers need to listen to the evidence and implement best practices to reduce the incidence and prevalence of adverse outcomes such as pressure ulcers. An important research article on pressure ulcer prevention recently came out in …Read More
Common Questions on Coding for MDS 3.0 Section M: Skin Conditions
I recently gave another training session for nursing home professionals for MDS 3.0 Section M: Skin Conditions. In the audience were nurses, directors of nursing, administrators, MDS coordinators and a smattering of physical therapists, doctors, and social workers. After the didactic I fielded questions and decided to share the most common ones with my blog readers. Question 1: How do I code Section M0700 when …Read More
