Keep it On or Take it Off? New Techniques for Managing and Preventing Wounds

Transcription

1 Keep it On or Take it Off? New Techniques for Managing and Preventing Wounds Chrystalbelle Rogers, MSN, RN, CWCN Clinical Director Post-Acute Division, U.S. Molnlycke

2 Objectives: Healthcare Economics Overview Challenges of Skin integrity Solutions for Long Term management Resources for education and process

3 Healthcare Policy Overview: Post-Acute Environment Reimbursement policies and strategies are changing accordingly: IMPACT Act of 2014 Quality Reporting Measures VA MISSION Act of House Committee on Veterans Affiars The VA MISSION ACT of 2018 (Summary) Nicole Ogrysko June 6, 2018, Federal News Radio Congressional Budget Office, Baseline Projections for Selected Programs; Medicaid; March 2016 ; Department of Veterans Affairs

4 Healthcare Policy Overview: Impacting Critical Factors Economic Clinical Per-patient treatment costs in facilities Rising costs of readmissions IMPACT Act requirements in post-acute services Changes in episode-of-care guidelines Aging patient population Rise of chronic conditions Rise of mental health conditions

5 IMPACT ACT of 2014

6 IMPACT Act: Overview Why it matters to post-acute settings of care: On September 18, 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act). The Act requires the submission of standardized data with regard to quality measures, and patient assessment instrument categories by: Long-Term Care Hospitals (LTCHs) Skilled Nursing Facilities (SNFs) Home Health Agencies (HHAs) Inpatient Rehabilitation Facilities (IRFs) The required date to start this data collection is October 1, Of the five quality measure domains listed in the IMPACT Act, the first quality measure is: skin integrity and changes in skin integrity. It s an element your organization can control, and Mölnlycke can help.

7 IMPACT Act: Details on Skin Integrity Quality Measure and Potential Penalties For National Quality Forum (NQF), the skin integrity of a patient was a specific focus resulting in the adoption of this measure Percent of residents or patients with pressure ulcers that are new or worsened. (Short stay.) (NQF #0678) In accordance with the Act: post acute providers must begin reporting the new refined measure: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury readmissions within 30 days for a HAPU Stage 3 or 4 may receive a payment penalty by CMS there is a potential penalty for facilities that do not effectively collect and report data As it relates to goals to reduce readmission rates: hospitals risk additional penalties for readmissions of patients who had been discharged to post acute care settings within 30 days for additional acute care services there is a potential reduction in Medicare payments for higher-than-expected readmission rates over the previous federal fiscal year

8 IMPACT Act: Quality Reporting Program CMS has mandated a quality reporting program for all post-acute care centers. In accordance with the Act: All post-acute care centers MUST begin reporting by October 1, 2018 The IMPACT Act specifies that the data [elements] be standardized and interoperable so as to allow for the exchange of such data among such post-acute care providers and other providers and the use by such providers of such data that has been so exchanged, including by using common standards and definitions in order to provide access to longitudinal information for such providers to facilitate coordinated care and improved Medicare beneficiary outcomes What happens if quality data isn t reported? For those post-acute care facilities that fail to submit the required quality data, the result shall be a 2% reduction in your payment.

9 IMPACT Act: Data Element Library The mission of the CMS Data Element Library (DEL) is to create a comprehensive, electronic, distributable, and centralized resource of CMS assessment instrument content. The goals of the DEL are to: Serve as a centralized resource for CMS assessment data elements (questions and response options) Promote the sharing of electronic CMS assessment data sets and health information technology standards; and Influence and support industry efforts to promote Electronic Health Record (EHR) and other health IT interoperability Requirements for reporting assessment data begin October 1,

10 IMPACT Act: Six Priorities for the CMS Quality Strategy Make care safer Strengthen person and family engagement Promote effective communication and coordination of care Promote effective prevention and treatment Work with communities to promote best practices of healthy living Make care affordable IMPACT Act of 2014 Data Standardization & Cross Setting Measures. Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/IMPACT-Act-of-2014-Data-Standardization-and-Cross-Setting-Measures.html

11 IMPACT Act: Six Priorities for the CMS Quality Strategy Value add and Resources Make care safer Mölnlycke products have set the industry standard and are clinically proven to promote the optimum healing of advanced wounds. Strengthen person and family engagement Promote effective communication and coordination of care Mölnlycke provides a full array of clinical experts in the field for ongoing training and education around wound treatment and specific product functions. Promote effective prevention and treatment Mölnlycke can help your organization now with long-term planning, including PU prevention tools, positioners and more. Work with communities to promote best practices of healthy living Make care affordable Mölnlycke can help your organization avoid penalties with a renewed focus on skin integrity and partnering with the industry leader.

12 IMPACT Act: Summary The IMPACT Act will affect your system over the coming years, both in terms of the data you are required to provide, and the results of your patient care taken as a whole. The future landscape of Medicare reimbursement is one where those facilities who provide the best patient care will receive prescribed reimbursement levels, and those who do not will find it challenging to stay in business. Note that skin integrity and changes in skin integrity are core areas of focus for post acute care facilities. Molnlycke can assist your organization now: Healthcare economics specialists to consult on your metrics and steward you through all the regulations Clinical specialists to train your teams and provide ongoing counsel on dressing selection, frequency, and use Product specialists to keep you informed of new technologies and applications Preventive tools and products to limit pressure ulcers and provide earlier wound care intervention strategies Industry-leading products that are clinically proven to preserve skin integrity and manage wounds while providing comfort, limiting pain, and reducing infection Partnership in your long-term economic health: the right choices today can save you millions over the life and growth of your facility(ies)

13 Where do our economic and clinical challenges meet? Pressure injury prevention and management Skin tears Chronic wounds

14 Imperativeness of Skin Skin is the largest organ in the body Skin is dry and fragile in the elderly population Daily exposure to: sun irritants chemicals mechanical trauma Normal Skin

15 Challenges to Geriatric Population Physiological changes related to the aging process: Degeneration of collagen and elastin fibers - 20% decrease in dermal and epidermal thickness - - Thinning and flattening of the dermal/epidermal junction Subcutaneous tissue loss Reduced function in sweat gland secretion Diminished dermal proteins Thinning of blood vessels Increased epidermal water loss Decreased tensile strength Reduced sensation Pittman, J, Effect of aging on wound healing. JWOCN July/August 2007;

16 Challenges of Geriatric Population: Skin Tears The most common of all wounds can also be the most challenging to effectively treat. Definition: Occurrence: U.S. 2 A skin tear is a wound caused by shear, friction, and/or blunt force, resulting in separation of skin layers. A skin tear can be partial-thickness (separation of the epidermis from the dermis) or full-thickness (separation of both the epidermis and dermis from underlying structures.) 1 Over 1.5 million documented skin tears annually among institutionalized adults in the Impact: Complications can increase morbidity or mortality risks Causes patient pain, anxiety, infection and delayed healing May increase facility cost and caregiver time Dressing challenge: Need to preserve the skin flap and protect surrounding tissue while reducing the risk of infection 1. LeBlanc K, Baranoski S, Skin Tear Consensus Panel Members. Skin tears: state of the science: consensus statements for the prevention, prediction, assessment, and treatment of skin tears. Adv Skin Wound Care 2011;24(9 Suppl): Stephen-Haynes et al., An appraisal of the clinical performance and economic benefits of a silicone foam in a large UK primary care organization. Journal of Community Nursing November 2013

17 Challenges of Geriatric Population: Skin Tears istap Classification System 1 Type 1: No skin loss Type 2: Partial flap loss Common Appearances At-risk skin Viable skin flap Light exudate Moderate exudate Type 3: Total flap loss High exudate 1. istap classification system: LeBlanc, K., Baranoski, S., Christensen, D., Langemo, D., Sammon, M.A., Edwards, K., Holloway, S., Gleockner, M., William, A., Sibbald, R.G., Regan, M. (2013) International Skin Tear Advisory Panel: A Tool Kit to Aid in the Prevention, Assessment, and Treatment of Skin Tears Using a Simplified Classification System. Advances in Skin & Wound Care; 26:

18 Challenges of Geriatric Population: Skin Tears 1. istap classification system: LeBlanc, K., Baranoski, S., Christensen, D., Langemo, D., Sammon, M.A., Edwards, K., Holloway, S., Gleockner, M., William, A., Sibbald, R.G., Regan, M. (2013) International Skin Tear Advisory Panel: A Tool Kit to Aid in the Prevention, Assessment, and Treatment of Skin Tears Using a Simplified Classification System. Advances in Skin & Wound Care; 26:

19 Challenges of Geriatric Population: Skin Tears 1. istap classification system: LeBlanc, K., Baranoski, S., Christensen, D., Langemo, D., Sammon, M.A., Edwards, K., Holloway, S., Gleockner, M., William, A., Sibbald, R.G., Regan, M. (2013) International Skin Tear Advisory Panel: A Tool Kit to Aid in the Prevention, Assessment, and Treatment of Skin Tears Using a Simplified Classification System. Advances in Skin & Wound Care; 26:

20 Challenges of Geriatric Population: Skin Tears 1. istap classification system: LeBlanc, K., Baranoski, S., Christensen, D., Langemo, D., Sammon, M.A., Edwards, K., Holloway, S., Gleockner, M., William, A., Sibbald, R.G., Regan, M. (2013) International Skin Tear Advisory Panel: A Tool Kit to Aid in the Prevention, Assessment, and Treatment of Skin Tears Using a Simplified Classification System. Advances in Skin & Wound Care; 26:

21 Challenges of Geriatric Population: Skin Tears Because of the loss of attachment, skin layers can move independently This allows even minor trauma to shear the layers apart and cause a skin laceration (tear) During activities which include: Removing tape Starting an IV Moving the patient up in bed Holding an arm to ambulate Bathing, toileting and dressing Bumping into objects Ratliff C, Fletcher K, Skin tears: a review of the evidence to support prevention and treatment. Ostomy Wound Management, 3:Mar 2007; Bank D, Nix D, Preventing skin tears in a nursing and rehabilitation center: an interdisciplinary effort. Ostomy Wound Manage. 2006;52(9):38 46

22 Skin Tears Prevention and Management of Wounds Light to moderate exudate Primary Objective: Provide Moist Wound Healing Environment Mepitel Mepitel One Mepilex Border Lite Mepilex Border Flex Mepilex Lite Moderate to high exudate Primary Objective: Manage Exudate Mepitel Mepitel One Mepilex Transfer Mepilex Transfer Ag Mepilex Border Mepilex Border Flex Mepilex Border Ag Mepilex Ag Normlgel AG Tubigrip Dermafit

23 Challenges of Geriatric Population: Pressure Ulcers What is a pressure ulcer? A localized injury to the skin and/or underlying tissue Usually over a bony prominence Caused by pressure and/or shear National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge Media: Perth, Australia; 2014 p. 18

24 Challenges of Geriatric Population: Pressure Ulcers Staging

25 Challenges of Geriatric Population: Pressure Ulcers Healthcare professionals agree that effectively positioning and repositioning a patient is the cornerstone of pressure ulcer prevention. 1 Sacrum pressure ulcers Heel pressure ulcers Occiput pressure ulcers Medical device-related pressure ulcers 1. Walters, T., Short, M., Lloys, J. et Al. AORN Ergonomic Tool 2: Positioning and Repositioning the Spine Patient on the OR Bed. AORN Journal, April 2011 Vol93 No4

26 Challenges of Geriatric Population: Pressure Ulcers Medicare estimates that each pressure ulcer adds $43,180 in costs to a typical hospital stay* Cost of individual patient care ranges from $20,900 to $151,700 per pressure ulcer More than 17,000 lawsuits are related to pressure ulcers each year; second most common claim after wrongful death, and greater than falls or emotional distress * US Department of Health & Human Services; Agency for Healthcare Research and Quality.

27 Challenges of Geriatric Population: Pressure Ulcers The heel and the sacrum are two of the most common locations for pressure ulcers Occurrence: 2.5 million people in the U.S. develop pressure ulcers 1 Impact: About 60,000 patients die annually as a direct result of pressure ulcers 1 Estimated to cost a facility $10,669 per occurrence 2 Damaging to reputation and referrals Prevention strategy: Based upon patient s risk level, prevention strategies might include: Prophylactic dressings Turning and positioning system Fluidized positioners Heel boots Air mattress 1. Preventing Pressure Ulcers in Hospitals. Content last reviewed October Agency for Healthcare Research and Quality, Rockville, MD Spetz J. et al. The value of reducing hospital-acquired pressure ulcer prevalence: an illustrative analysis. J Nurs Adm Apr;43(4): doi:

28 Challenges of Geriatric Population: Pressure Ulcers A worldwide problem affecting patients in all settings across the continuum of care, there are many risk factors for acquiring pressure ulcers that cross age and gender lines 1 Intrinsic Risk Factors General health Nutrition Skin moisture Medications Perfusion Mobility/activity Skin moisture Age Previous pressure ulcers Extrinsic Risk Factors 2 Pressure Shear Friction Skin microclimate 1. Patient Risk Factors for Pressure Ulcer Development: Systematic Review. Coleman et al. International Journal of Nursing Studies 50 (2013) 2. World Union of Wound Healing Societies (WUWHS) Consensus Document. Role of dressings in pressure ulcer prevention. Wounds International, 2016.

29 Translating Risks Into Intervention Interventions will vary according to the sub-scale. Initiate appropriate care plan interventions for:» Total Score of 18 or less» Any subscale of 2 or less 1. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.) Cambridge Media: Perth, Australia; Pg Ayello, E.A. (2012). Predicting pressure ulcer risks. Hartford Institute for Geriatric Nursing, New York University, College of Nursing. Retrieved from

30 Implementing Solutions for Individualized Care

31 Wound Care Product Goals Manage wounds Reduce pain in wound care Prevent pressure ulcers Prevent infection

32 Pressure Ulcers Filed claims for nursing home-acquired pressure ulcers are the second most commonly filed claim after wrongful death. The average compensation for a pressure ulcer case is almost $1 million pieces of clinical evidence support prophylactic Mepilex Border dressing use for pressure ulcer prevention 76% reduction in pressure ulcers 2 Santamaria et al 88% reduction in pressure ulcers 3 Kalowes et al Economic evidence from 1.03M patient cohort study 4 $77 reduction per patients treatment costs ($43 from $120) Potential savings of $200,000 - $600,000 per hospital 1. Fowler E. et al. Practice Recommendations for Preventing Heel Pressure Ulcers. Ostomy Wound Management 2008;54(10): Santamaria, N., Gerdtz, M., Sage, S et al. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 2015;12:3, Kalowes P, Messina V et al. Five-layered soft silicone foam dressing to prevent pressure ulcers in the intensive care unit. Am J of Critical Care 2016;25:6, Padula WV. The Real-World Effectiveness and Value of Sacral Dressings to Prevent Hospital-acquired Pressure Injuries in Academic Medical Centers: An Observational Cohort Study. Poster presented at SAWC, Spring 2017.

33 Pressure Ulcer Prevention: How do we protect long term? Type of Pressure Ulcer`` Dressings Turning & Positioning Systems Positioning Boots/Offloaders Tapes Sacrum Mepilex Border Sacrum Z-Flo Fluidized Positioner Tortoise Turning & Positioning System Static Air Mattress and Seat Cushion Heel Mepilex Border Heel Z-Flex Fluidized Heel Boot Static Air Boot Occiput Z-Flo Fluidized Positioner Medical Device Mepilex Border Mepilex, Mepilex Lite Mepitac Mefix Mepilex Border Sacrum is the industry leader in sacral pressure ulcer prevention, and may be used as a prophylactic to avoid facility-acquired pressure ulcers. Our complete line of turning & positioning systems are designed to protect at-risk anatomical sites and offload bony prominences.

34 Mölnlycke Product Benefits: General Wound Management Each wound is different, so we make a range of advanced wound care products Antimicrobial products that serve as a barrier to microbial penetration including silver impregnated dressings and antimicrobial hydrogel Film products that are breathable, transparent and shower-proof Foam dressings for protection and absorption Wound contact layers that protect the sensitive granulated wound bed and ensure a moist wound environment Alginate/debriding/gel products used to debride wounds, support exudate management and add moisture to dry wound Wound Management Checklist Absorbency and retention Conformable Antimicrobial Breathable and showerproof

35 Solutions: Preventing Pressure Ulcers Prevention Options Mölnlycke Dressings Mepilex Border Sacrum Mepilex Border Heel Mepilex Border Mepilex Lite Mepilex Prevention Options Mölnlycke Devices Z-Flo Fluidized Positioners Tortoise Turning & Positioning System Z-Flex Fluidized Heel Boot Static Air Boot Static Air Mattress Static Air Seat Cushion

36 Solutions: Preventing Pressure Ulcers

37 Solutions: Preventing Pressure Ulcers

38 Pressure Ulcer Prevention and Management Pressure Ulcer Management Mepilex Border Sacrum Mepilex Border Sacrum Ag Mepilex Border Heel Mepilex Border Mepilex Border Ag Mepilex Border Flex Mepilex Ag Mepilex XT Lyofoam Max Exufiber Exufiber Ag Melgisorb Plus Melgisorb Ag Mepore Film

39 Gentle healing: Reduce Pain Safetac technology dressings are clinically proven to minimize pain during dressing changes. 1 That means less stress 2 and fewer disturbances to the wound, which can mean faster healing 3 and result in lower costs. 4 Pain from dressing changes is often a result of adhesives damaging the wound and skin 1 Pain (and the anticipation of pain) cause significant stress, which is proven to delay healing 2 Preventing delays to healing minimizes the costs for additional treatment time 4 It also saves on analgesic and anxiety medication, and other costs associated with painful wounds 4 1. White R. A Multinational survey of the assessment of pain hen removing dressings. Wounds UK, Upton D et al. Pain and stress as contributors to delayed wound healing. Wound Practice and Research, Upton D et al. The Impact of Atraumatic Vs Conventional Dressings on Pain and Stress in Patients with Chronic Wounds. Journal of Wound Care, Butcher M. et al. Quantifying the financial impact of pain at dressing change. In: Psychological Impact of Pain in Patients with Wounds. Upton D, ed. Wounds UK: London, 2011.

40 Reduce Pain, Promote Gentle Healing Peel Force Pain Survey 3,000+ patients 20 countries Multiple wound types Compared four types of dressings Comparison of dressings in terms of pain severity scores Outcome: Dressings with soft silicone adhesive technology benefit patients in terms of significantly reducing pain during wear, at dressing removal, and after dressing change, when compared to dressings with traditional adhesives. 93% of patients wished to continue with the dressing with Safetac technology Dykes, P.J., Heggie, R., Hill, S.A. (2001) Effects of adhesive dressings on the stratum corneum of skin. J Wound Care 10 (2): 7-10; Dykes, P.J., Heggie, R. (2003) The link between the peel force of adhesive dressings and subjective discomfort in volunteer subjects. J Wound Care 12 (7): 260-2; Dykes, P.J. (2007) The effect of adhesive dressing edges on cutaneous irritancy and skin barrier function. J Wound Care;16 (3):97-100; Soon, K., Acton, C. (2006) Pain-induced stress: a barrier to wound healing. Wounds UK 2 94): ; WUWHS (2004) Principles of best practice: Minimising pain at wound dressing-related procedures. A consensus document.

41 Reduce Maceration Safetac technology seals the wound margins, preventing the spread of exudates that can cause maceration of healthy periwound skin and patient discomfort Meaume S et al. A study to compare a new self adherent soft silicone dressing with a self adherent polymer dressing in Stage II pressure ulcers. Ostomy Wound Management, Feili F et al. Retention capacity. Poster presentation at the EWMA conference, Lisbon, Portugal, Wiberg A.B et al. Preventing maceration with a soft silicone dressing: in-vitro evaluations. Poster presented at the 3 rd Congress of the WUWHS, Toronto, Canada, 2008.

42 Clinical Evidence

43 Mölnlycke Clinical Evidence * Currently 1 RCT exists on Allevyn Life Quadrilobe dressing used for pressure ulcer prevention in orthopaedic surgery patients. However this dressing is different in construction to the Allevyn Life Sacrum dressing in the coccyx region where the sacrum dressing is only 3-layer construction and therefore this evidence is not transferable to the sacrum dressing. ** Includes three international clinical guideline documents which incorporate recommendations based on available research and expert opinion. Although the guidelines are not brand specific, the underlying clinical evidence identifies only Mepilex Border and not Allevyn Life, Optifoam, Aquacel Foam or Biatain. Evidence pyramid data current as of 4/2018.

44 Products in Practice: Reduce HAPU Incidence; Save Nearly $1 million (Acute Case Study) Case Study: St. Tammany Parish Hospital, Covington LA Two 10-bed critical care units evaluated Interdisciplinary team assembled to deploy and monitor results Identified Mölnlycke soft silicone bordered foam products Outcomes: - Upon initiation of program, HAPU incidence reduced by more than 50% in one quarter - HAPU incidence eliminated by 2 nd quarter of implementation - Two-year study estimates an initial savings of $840, Donovan, et al. Presented at Spring WOCN 2016

45 John s Hopkins University: Pressure Ulcer Prevention The Real World Effectiveness and Value of Sacral Dressings to Prevent Hospital-acquired Pressure Injuries in Academic Medical Centers. An Observational Cohort Study. William Padula J. Wound Ostomy Continence Nurs. 2017; 44(5); 1-6 Outcomes/Key Messages Six-year observational study, more than 1 million patients Conducted across 38 academic medical centers Examining Stage 3, 4, or Unstageable HAPU Specifically studied Mölnlycke Mepilex Border Sacrum On average, a hospital using a standard quantity of 1 to 2 dressings per hospitalized patient admission over 5+ days witnessed a 1.0 case reduction in PSI-03 (HAPI stages 3, 4, and unstageable) per quarter. Given that the average estimated cost of a PSI-03 ranges from $50,000 to 150,000, this implies that prophylactic 5-layer foam sacral dressings could save hospitals $200,000 to $600,000 per year in expenses associated with pressure injuries in addition to avoidance of CMS penalties for high hospital-acquired condition rates.

46 Applications in Long Term Care: Wound Treatment Acute and Chronic Wound Applications in the Long Term Care Setting for a Soft Silicone Foam Border Dressing with Silver: A Clinical Case Series Demonstrating VALUE. Diane L. Krasner, Wendy McKinney Outcomes/Key Messages Studied various wounds: trauma, pressure ulcers, skin tears Five case studies, all with a goal of absorbing exudate (among other aims) 60% of participants demonstrated healed wounds; 40% referred for debridement Mölnlycke dressings used exclusively in the case series Unequalled in its ability to reduce pain and trauma. Simple for staff to use and easy for resident s families and caregivers to learn to use at home or assisted living.

47 Mitigating Costs and Improving Outcomes: Pressure Ulcer Prevention The Evidence-based Prophylactic Dressing Reduces Hospitalacquired Pressure Injuries by 67% and Significantly Lowers Treatment Costs Jennifer Fimiani RN BSN CWON Penn Medicine - Lancaster General Hospital Outcomes/Key Messages Single hospital study, focused on prophylactic dressings from 2013 through 2017 Competitive dressings used as control (Allevyn) In late 2015, facility intervened with Mepilex Border Sacrum as prophylactic Post intervention, NO moisture-associated skin damage was observed A total of 39 fewer HAPI occurred in the 22 months post intervention than in the prior 22 months. The 39 fewer HAPI that occurred post intervention as compared to pre-intervention would have resulted in an estimated cost saving ranging from $432,120 to $3,070,158.

48 Creating a Bundle: Pressure Ulcer Prevention Bundling for Change: Implementing Pressure Injury Prevention Meredith Cooper, RN BSN-CCRN John Godke, MD FACCP Jobe Nasca, RN BSN Outcomes/Key Messages Single hospital study (24-bed critical care unit) focused on pressure injury prevention After a sharp spike in pressure injury incidence in 2016, new measures were instituted Facility bundled preventative interventions with Molnlycke products: Tortoise Turning & Positioning, Mepilex Border Sacrum, Z-Flex Heel Boot Most injuries were DTI Average incidence of HAPI decreased from 11.11% to 1.75% in roughly one year A significant reduction in ICU-acquired pressure injuries was achieved by using a bundled approach to reduce friction and shear. At minimum, the cost of treatment for a hospital acquired Stage 2 pressure injury is estimated at $10,000. Stage 3 and 4 pressure injuries can total upwards of $70,000 per incidence. The total cost of adding bundled interventions per patient including (2) heel boots, (1) positioning system and (1) sacral dressing was $

49 Patient Safety, Caregiver Safety : Turning and Positioning Economic Impact of a Safe Patient Handling and Mobility System on Staff and Safety in a Long Term Subacute Care Unit Jan Kass, RN BSN CWON Outcomes/Key Messages Single hospital study (64-bed long term subacute care unit) 60 patients studied (predominantly immobilized) Facility implemented Mölnlycke Tortoise Turning & Positioning System Prior to study, nine staff injuries were directly related to patient repositioning In the one-year comparison, only one injury occurred Implementing a NRSSPS with the specific features shown, as part of a comprehensive SPHM program, played an integral part in the reduction of MSD staff injuries by 89% over one year. The cost of implementing the NRSSPS for 60 patients over the one year period was $15,852.00; resulting in a direct cost savings of $108,

50 Safe Patient Handling and Pressure Ulcer Prevention Connecting the Dots: Pressure Ulcer Prevention and Safe Patient Handling A. Chenel Trevellini, RN BSN CWOCN Outcomes/Key Messages Single hospital study (300-bed acute care hospital) Identified a problem of staff injuries related to turning and repositioning patients Concluded that boosting, turning and positioning immobilized patients were effective in reducing facility-acquired pressure ulcers 2013 incidents and claims related to patient handling (turning, positioning, boosting patient in bed) were reduced by 55% compared with 2012 claims. The 2013 bed rental usage was decreased by 66% from 2012, resulting in a $58k cost savings.

51 Providing Solutions to Top Health Care Challenges Sources: 1. Järbrink et al. Systematic Reviews (2016) 5: MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN pdf 3. Infect Control Hosp Epidemiol June ; 35(6): ly.com/releases/2017/01/ htm Bureau of Labor Statistics, 2011 Data 10.