Can We Talk?: Pressure Ulcers — A National Embarrassment

    One particular aspect of the Terri Schiavo case struck a chord.

    Terri Schiavo was at extremely high risk for developing pressure ulcers, yet according to news reports, she had none. I have very mixed reactions — I was impressed with the care she received and I was also angry.

    Terri’s caregivers achieved a pressure ulcer-free result under severe circumstances while across the country thousands of patients at lower risk develop pressure ulcers. The time has come to stop all of the excuses and take responsibility for preventing pressure ulcer occurrence.

    Why do we as professionals and regulatory agencies such as the Centers for Medicare and Medicaid Services and its state inspectors accept mediocrity? The incidence of pressure ulcers in hospitals and nursing homes is sometimes 20% or higher — ie, one in five patients may develop a pressure ulcer. We all have to ask a fundamental question: Why do we accept poor quality care when a patient develops a pressure ulcer? If we were told that one in five patients with diabetes received the wrong dose of insulin or had undergone the wrong operation, we would be appalled, demand immediate action, and hold those responsible accountable for the lack of quality. Why do pressure ulcers escape our wrath and indignation?

    Frankly, reading our wound care and nursing journals and attending seminars is frustrating. Rarely does an article or speaker deal with quality of care as it pertains to the high incidence of pressure ulcers. The only professionals asking hard questions are the lawyers.

    To rectify this situation, we need to ask and answer the following:
  1. Who is responsible for quality care in hospitals and nursing homes and why aren’t we doing our jobs?
  2. Why do we, as healthcare professionals, accept such a low standard of care pertaining to pressure ulcers compared to other areas of healthcare?
  3. How many more patients have to suffer or die before we do something about our apathy?

    Our excuses are no longer valid. We know that in the majority of cases, evidence-based best practice works but it needs proactive implementation. Nothing is going to change unless we as professionals demand a change. We have a moral obligation to deliver quality care to our patients — and based on the incidence of pressure ulcers across the country, too many of us, frankly, are doing a lousy job. If we continue to keep our expectations low, nothing will change our outcomes.

    I am often accused of being unrealistic. Nonsense! Terri Schiavo’s caregivers met the challenge. It’s time for the rest of us to do the same.

    Can We Talk? is a new column intended to perpetuate the lively exchange of ideas fostered by the Symposium on Advanced Wound Care as well as to maximize our resources as an interactive publication. If you have an opinion on a topic relevant to the Ostomy Wound Management audience, please email your thoughts to bzeiger@hmpcommunications.com. Accepted articles will be published with author approval in the print and online versions of the journal.