Feb. 8, 2000 (Atlanta) -- The development of pressure ulcers, also known as bedsores, often leads to malpractice suits, but legislation is improving the quality of nursing home care, according to two reports in the January issue of the Journal of theAmerican Geriatric Society. Experts say pressure ulcers, which are seen as an indicator of the quality of nursing home care, are largely preventable.
When Congress passed the Omnibus Reconciliation Act of 1987, every aspect of nursing home law was changed. The regulations require a nursing home to make a detailed assessment of a resident's condition when he or she is admitted, to create a detailed plan of care based on the assessment, and to maintain the resident at the highest possible level of functioning.
Bedsores occur in people unable to change position in bed. In order to prevent these ulcers, the person needs to be turned frequently, often every two hours. The development of pressure ulcers is often complicated by bladder or bowel incontinence.
In order to evaluate how well this legislation has improved nursing home care, researchers reviewed over 170 pressure ulcer cases recorded in the last 60 years. Settlements greater than $50,000 were defined as favorable for the plaintiff; settlements less than $50,000 were defined as favorable for the defense.
The data showed that over 90% of these cases were recorded just in the last 15 years, and 75% involved nursing homes. After Congress passed the reform act, the number of pressure ulcer cases brought to the court increased significantly. However, the amount of money awarded in each case remained the same. The chief investigator says the law is working as intended.
"Even though the number of identified pressure ulcer cases increased after the legislation, the percentage of successful plaintiff cases did not," says Richard Bennett, MD, executive medical director of the Johns Hopkins Geriatrics Center and associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore. "The regulations provided plaintiff attorneys with the means to develop cases and defense attorneys with the means to disprove them." Bennett tells WebMD that family members should take an active role in prevention.
"Pressure ulcers are one of the most common adverse events that occur in hospitals and nursing homes. But often, they can be prevented," says Bennett. "Family members of frail, immobile, or incontinent patients should ask about prevention efforts and take an active role in the plan of care." Geriatricians say quality of care has improved since the reform effort.
In a separate study of over 100 nursing homes, researchers monitored pressure ulcer rates for six-month periods. Based on the medical charts of over 30,000 residents, the data showed that pressure ulcers decreased 25% between 1991 and 1995. And the ulcers that did develop were less likely to be severe. The lead author tells WebMD that pressure ulcer rates are signs of overall quality.
"Pressure ulcers are an excellent quality measure because prevention and treatment requires well-coordinated, multidisciplinary care," says Dan Berlowitz, MD, MPH. "And the decrease we observed is probably the result of reform measures like comprehensive physical assessments, quality improvement programs, and intensive prevention efforts." Berlowitz is associate director of the Center for Health Quality, Outcomes, and Economic Research at Bedford Veterans Affairs Hospital and associate professor of medicine at Boston University School of Medicine.
Nursing experts say prevention begins with education. "Prevention programs should be based on guidelines established by the Agency for Health Care Policy and Research," says Dorothy Doughty, MSN, RN, president of the Wound, Ostomy and Continence Nurses Society and director of a nursing education program by the same name at Emory University in Atlanta. "And regular staff training on turning, positioning, padding, and pressure relief is an important component. Additionally, new admissions should be assessed for risk with standard screening tools. That way, facilities can allocate prevention resources more effectively," she tells WebMD.
The nursing home study was funded in part with a grant from the Agency for Health Care Policy and Research.
- Pressure ulcers or bedsores are one of the most common adverse events that occur in nursing homes.
- Reform laws passed by Congress have increased the number of lawsuits due to bedsores, thereby improving the quality of nursing home care.
- Bedsores can be prevented, so family members of frail, immobile, or incontinent patients should address this issue with health care providers.