Improving Wound Care Costs and Outcomes with Pressure Ulcer (PU) Census

What is Pressure Ulcer Census, and How Does It Relate to Advanced Wound Care Costs?

This month’s blog is about pressure ulcer (PU) census. The first question is why do you need to know the census? Census can be used to determine personnel distribution (e.g., skill level and numbers), material costs (e.g., wound care dressings) and of course, it is important to have documentation in place regarding your pressure ulcer census to help reduce the risk of surveyor and repayment issues that can result from facility.

Senior LTC advanced wound care

Census can be either the number of patients with pressure ulcers or their number of pressure ulcers during a defined period of time. In fact, this number may be higher than the number of patients with pressure ulcers. The costs related to pressure ulcer prevention costs are usually determined by each patient, however treatment costs should be calculated by patient and by each pressure ulcer.

Why? If a mattress or bed is ordered to redistribute pressure or manage microclimate (prevention), the cost is by patient. If the patient has two ulcers, one is treated with NPWT and one with a foam dressing, the NPWT ulcer costs considerably more to treat per day (but not necessarily more overall) than the ulcer treated with foam. The stage of the ulcer, tunneling, sinus tracts and infection can also dramatically increase the cost of treatment.

Hospitals determine pressure ulcer census by performing either prevalence studies with chart review to determine hospital acquired (by unit, specialty, monthly or yearly) or by prevalence and incidence (assessing patients with intact skin on prevalence review that develop pressure ulcers over a specific time period). These numbers give the facility data to evaluate prevention interventions and determine costs of treatment. Long-term care (LTC) and home care settings can perform prevalence studies with chart review for acquired pressure ulcers, however, in many cases, incidence is difficult to determine based on the long and sometimes variable lengths of stay.

In LTC, patients can be admitted that are at high risk for the development of pressure ulcers that need prevention interventions. Patients that already have pressure ulcers are also admitted, which is part of PU prevalence (“prevalence”=number of patients with ulcers) that will need treatment for the ulcer(s) to close or heal it/them, or to prevent it/them getting worse. These patients may also need prevention measures to prevent new ulcers from forming.

Most importantly, as far as payment for the cost of treatment, patients can develop ulcers after admission (also called “PU Incidence”) due to prevention not being effective or because the ulcer is documented as “unavoidable.”

The Centers for Medicare and Medicaid Services' (CMS) tool for facilitating care management in nursing homes is called the Minimum Data Set (MDS), a core set of screening and assessment elements that is part of a Resident Assessment Instrument (RAI). The RAI provides a comprehensive and standardized assessment of each LTC facility resident's functional capabilities and helps staff to identify health problems. This assessment is performed on every resident in a Medicare and/or Medicaid-certified LTC facility. More specifically, the MDS 3.0 includes areas for documenting the number of Stage I–IV pressure ulcers, unstageable ulcers, worsening ulcers and healing ulcers. The MDS can then also be used to determine patient and pressure ulcer census by stage.

I hope this information on pressure ulcer census has shown you the importance to knowing the “count” on pressure ulcers and how the data can support prevention interventions, treatment choices and evaluation of interventions.

This is my last blog topic as it relates to the broader “100,000-foot view” of challenges in developing and delivering quality advanced wound care management programs. I hope you have enjoyed reading—and learned something from—them as much as I have enjoyed writing them!

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