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Stopping Pressure Ulcers-Before They Start

May 1, 2004
by root
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Interview with Steve Mogensen and John Hertig

We've also seen dramatic results. For example, in one case the scanner identified a significant problem developing on a resident's heel, and the facility provided pressure relief-before a visible wound developed. They tracked the developing wound's improvement once the pressure was relieved; the tissue damage reversed and the wound healed and never broke through the skin.

Zinn: In which residents should a scan be obtained, to determine if they have any developing pressure ulcers that are not yet otherwise detectable?

Mogensen: All new admissions should be assessed, to determine whether they are at high, moderate, or low risk for developing pressure ulcers. The Braden scale is incorporated into the scanner's software, so staff can ask the questions for that scale, which are right on the screen, and input the answers into the computer. If the Braden scale shows that the person is at risk of contracting an ulcer, that person can be scanned then and there. Bony prominences of the body where pressure ulcers could develop can be scanned in approximately five to ten minutes.

Most facilities are doing risk assessments on a regular basis, as well, so when any resident falls into the high-risk category, scans should be done. We also encourage nurses to rely on their own intuition and obtain scans even when they suspect a problem is developing in a resident considered to be only at moderate risk, to confirm or rule out their suspicion.

Scans should also be performed on anyone who's going to be leaving the nursing home for any length of time; e.g., before hospitalization, to get a baseline. The scans should be repeated when the person returns to the home, to make sure he or she hasn't started to develop a pressure ulcer.

Hertig: There's always a concern that nursing homes are inheriting pressure ulcers from hospitals when residents are there for a period of time. This technology takes the subjectivity out of it. If you detect problems on the scan, you can record the fact that these problems developed in the hospital, or in the resident's home before admission to the nursing home, and you can take action before it becomes a big problem.

Zinn: How often should scans be obtained in residents who have already developed pressure ulcers, to determine whether the treatment they are receiving is working or if it needs to be changed for more effective healing?

Mogensen: Once a week is usually sufficient. Without this technology, the way in which wounds are measured is rather subjective; i.e., if three different people measure a wound at one-week intervals, their measurements may not be consistent enough to show whether a wound is really healing or not. Scanning the wounds is an objective way to accurately measure the surface area and depth of a wound and document whether it's healing.

Zinn: How much do your services cost a long-term care facility?

Mogensen: The cost is calculated for each facility based on the number of residents, the acuity level of the population, and the facility's current pressure ulcer incidence. Facilities sign an annual contract and then pay a monthly fee that includes use and maintenance of the scanner, hardware and software updates, clinical staff training, and our radiologists' services.

The average monthly fee is $3,000; it can be less, and it can be more if the home is very large or has an exceptionally high-acuity population. The monthly service fee is all-inclusive and will not vary with the number of scans the facility performs; if the staff want to scan 2 or 20 residents a day, the cost remains the same. Also, the cost of providing the capital equipment is included in that monthly fee.

Hertig: We opted not to charge for our services on a per-scan basis because we didn't want to create a disincentive. We don't want to discourage staff from performing as many scans as are needed. The more the merrier, really, because that means they're applying best practices.

Zinn: Is the cost of using this technology offset by the savings realized from pressure ulcer prevention and possibly providing shorter duration of wound treatment?

Hertig: We hope data will be published shortly in a study conducted by a 140-bed nursing home that's been using this technology. The researchers collected the hard-dollar costs (i.e., checks written for medications used to treat pressure ulcers, dressings, etc.), but not soft costs, such as nursing time. The facility was able to lower its direct costs of pressure ulcer treatment by 25%. In an average nursing home, those savings would be sufficient to cover the cost of our services.

All the other benefits, such as improved resident care and reduced exposure to litigation and survey deficiencies, weren't even taken into account. Instead of writing checks to treat pain and suffering, facilities using this technology are writing checks to prevent pain and suffering. As a result, nursing staffs using this technology love it, because it helps them do what they like to do-prevent problems before they occur. It allows them to spend a small amount of their time preventing pressure ulcers instead of a great deal of their time changing dressings on difficult-to-heal wounds.

Zinn: I understand you're attempting to get CMS to approve Medicare reimbursement for this technology. How is that progressing?