Considering that the body is packaged up by a wonderful “wrapping paper” that keeps all the organs and other components safely anchored inside, it is hardly a surprise that nurses and other health professionals get a bit neurotic about ensuring that the skin remains healthy and intact, especially when considering individuals with mobility problems or those with smaller adipose deposits acting as insulation and protection. Some diseases or medications, such as diabetes and steroids, slow the ability of the skin to heal, opening the body to greater chances of infection. Those with decreased mobility, especially individuals who are underweight and have a smaller muscle mass, are at a higher risk of “breaking through” the skin from the inside (commonly known as decubiti, pressure ulcers or bedsores). Healing a wound caused by immobility, especially in the perineal area (think about the area covered by underwear) is quite difficult and keeping the area clean is almost impossible if the individual is also incontinent.
These concerns are especially evident in dealing with the elderly who are less mobile and have decreased protections, and in those who are bedbound or have suffered catastrophic injuries and are wheelchair or bedbound. Healthcare Finance (2019)[1] notes that the risk of a pressure ulcer in trauma wards is 100%. Impeccable skin care provided by all caregivers and nurses is mandatory to ensure that skin remains intact. The best skin care starts with repositioning every two hours and great perineal care, especially with toileting and incontinence care. When the individual is repositioned, padding vulnerable areas with pillows such as bony prominences like the elbows, heels, ankles and knees helps prevent skin breakdown in those areas.
Healing pressure ulcers is a long, expensive process depending on the severity of the wound. Wounds are staged I-IV, with stage I showing damaged skin, but no actual “breach” of the tissue up to Stage IV and unstagable wounds where the wound is through the full thickness of the skin with exposed bone, tendon or muscle. According to Healthcare Finance [2], the facility cost for caring for individuals with pressure ulcers is over $14 million dollars per year, and CMS (Centers for Medicare and Medicaid) spends $22 billion per year on pressure ulcers as a secondary diagnosis. If an individual develops a pressure ulcer after admission to a hospital or skilled nursing facility, that facility incurs the costs of healing that wound and its sequelae. The facility also is subjected to a 1% penalty from CMS for wounds developed while an inpatient, not to mention the potential of litigation, since about 2.5 million people per year suffer from pressure ulcers, and an estimated 60,000 die from the sequelae of those ulcers, generally infection.
When reviewing medical records, it is imperative to consider
the skin care provided to the patient, and medical costs projections/Life Care
Plans need to include skin care measures to help protect the injured person
from not only pressure ulcers, but also infections and other problems caused by
those wounds.
[1] https://www.healthcarefinancenews.com/news/pressure-ulcers-cost-health-system-268-billion-year
[2] https://www.healthcarefinancenews.com/news/pressure-ulcers-cost-health-system-268-billion-year
