Androscoggin Valley Hospital (AVH) is a 25 bed critical access hospital located in the white mountains of New Hampshire.  AVH may be small, but the hospital is home to a wide variety of services and technologies that place it on the level of much larger facilities.

Click Here to See the Dalcon/Polycom AVH Success Story PDF

The staff at Androscoggin is serious about fall prevention.  Patients are assessed for fall risk factors upon admission and at each shift. Patients determined to be at risk of falling are placed in a special program called the “ruby slippers” program.  The ruby slippers program is designed to make staff aware of a patient’s fall status and put additional preventative measures in place, such as ambulation assistance.  Ruby slipper patients and their families are educated on the seriousness and importance of the program.

Investing in New Fall Prevention Technology

Kirk 4040 with Bed Fall Alert
AVH uses Stryker bed alarm systems for ruby slipper patients who are disoriented or unable to follow directions or call for assistance.  When a patient on bed alarm begins to sit up to get out of bed, the Stryker bed sets off an audible alarm.  Additionally, this bed alarm is captured by AVH’s Dalcon Alert Remote Patient Monitoring system.  Dalcon Alert forwards the bed alarm directly to Kirk phones carried by hospital staff.  The wireless phones receive a text message that communicates the location and type of alarm.  As a result, clinicians know exactly which room to respond to decreasing the time of response.

When responding to a fall alarm, time is of the utmost importance.  A few seconds can be the difference between finding a patient still trying to get out of bed, and finding a patient on the floor.  As an added measure to buy clinicians more time to respond, Dalcon Alert relays audible announcements in the patient room telling the patient to “please get back into bed, your nurse is on the way” when a bed alarm is tripped.

Measuring Results

The emphasis Androscoggin has placed on fall prevention has been successful.  Since implementing Dalcon Alert and incorporating the system’s fall prevention technology into their fall policy, AVH’s fall rate has dropped significantly.

The average fall rate, measured in percentage of patients who fall for the three quarters Dalcon Alert has been installed at AVH is 0.43%.  The average fall rate for the three quarters before the Dalcon Alert installation was 0.67%.  Thus the average for the three quarters after installing Dalcon Alert resulted in 36% fewer falls than the average for the three quarters prior to Dalcon Alert being installed.

Since the Centers for Medicare & Medicaid Services (CMS) began to refuse reimbursement to hospitals for hospital acquired stage III/IV pressure ulcers labeled “never events,” there has been considerable controversy surrounding the subject.

Stage III/IV pressure ulcers are serious wounds that are very expensive to treat, some cases costing upwards of $70,000.  Not only has CMS refused to pay for the treatment of these events, private insurers have followed suit as well.  Additionally, hospitals are prohibited from passing the costs on to the patients of their families.

Compounding the high costs, late stage decubitus ulcers occur relatively frequently.  The National Pressure Ulcer Prevalence Survey showed that late stage decubitus ulcers occurred in approximately 0.65% of all patients in US acute care hospitals on average.

Are Decubitus Ulcers 100% Preventable?

The source of the controversy is from the concept that some experts believe that not all decubitus ulcers are preventable, regardless of the usage of best practices and technology.  Lee Ann Krapfl, a wound care nurse and recent public policy committee chair of the Wound, Ostomy and Continence Nurses Society, notes that CMS itself has stated not all decubitus ulcers are preventable.  In the long term care setting, CMS states, “a resident who enters the facility without pressure sores [must] not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable.”

According to CMS, “unavoidable” means: “the resident developed a pressure ulcer even though the facility had evaluated the resident’s clinical condition and pressure ulcer risk factors; defined and implemented interventions that are consistent with resident needs, goals, and recognized standards of practice; monitored and evaluated the impact of interventions; and revised the approaches as appropriate.”

Obviously, this seems to conflict with CMS’s policy regarding reimbursement of never event decubitus ulcers.  However it must be noted that this ruling is for long term care facilities, and it may well be that CMS is holding acute care facilities to a higher standard of care.

Incidentally, should CMS decide to change its stance on decubitus ulcers in acute care hospitals, there is a good chance it will place the burden of proof regarding the avoidability of a decubitus ulcer incident on the hospitals.

Regardless of the setting, experts agree that decubitus ulcer prevalence can be reduced significantly using best practices and technology.  Also, although experts disagree on the topic of unavoidable pressure ulcers, most agree that they are very rare if they exist.

FILED UNDER BLOG · TAGGED WITH CENTERS FOR MEDICARE & MEDICAID SERVICES, DECUBITUS ULCERS, NATIONAL PRESSURE ULCER PREVALENCE SURVEY, NEVER EVENTS