Pressure Ulcers/Case Study
Bedsores are also known as pressure ulcers. They are lesions that are primarily caused when soft tissues are pressed against bone for a long period of time, restricting blood flow to the area. These often occur when a patient is immobile or reclining in a recovery bed for a long period of time. They are common on the hips, elbows, knees, ankles and even the back of the head. Current research shows that they are exacerbated by other conditions like diabetes, perspiration, incontinence, infection, or medications that impair the circulatory system. Pressure ulcers are particularly serious in older patients — particularly those in a wheel chair or in cases in which the patient does not move or exercise. Bedsores are often fatal, even when treated aggressively and are one of the leading causes of death from complications in many developed countries — second only to adverse drug reactions (Preventing and Treating Pressure Ulcers, 2009).
Pressure ulcers are best treated through preventative care — turning the patient regularly so blood flow is not compromised, using catheters or impermeable dressings to keep the bed sheets dry, and shifting patients who are paralyzed on a regular basis or using pressure-distribute mattresses. Additionally, higher levels of Vitamin C seem to have an effect on those who develop bedsores, and in their healing (Preventing Pressure, 2011; Meschino, 2011).
Ironically, even though Medicare/Medicaid do not reimburse, or do not reimburse fully for pressure ulcers, more than 2.5 million people in the United States develop the sores. Within acute care, the incidence is up to 38% and in long-term care 24%. There is a far higher rate of pressure ulcers within intensive care units, likely due to immune compromised individuals, with 8-40% of patients developing the sores (Pressure Ulcers in America, 2001). In fact, the Centers for Medicare and Medicaid Services announced as far back as 2008 that it would no longer reimburse hospital for treating pressure ulcers because they are, in the view of the agency, preventable. Refuting this notion, however, are several academic papers and professional medical societies. This view holds that there are clinical circumstances in which pressure ulcers are unavoidable, even with excellent multidisciplinary care. Because the skin is the body’s largest organ, many diseases overwhelm the skin and even best practices cannot prevent pressure ulcers 100% of the time (WOCN Society, 2009).
Scenario – The situation involves a patient admitted to the hospital from a skilled nursing facility because of severe dehydration. Both the nursing facility and hospital often cross-refer patients, and there is a close relationship between the two facilities. Within a few days after admission, the hospital staff notices a pressure ulcer and claims that the sore was caused by the nursing facility. The nursing facility claims that there was no documentation of any skin issues prior to discharge and that the hospital is to blame. Besides the clear moral and ethical issues, there is also an issue of payment from Medicare, which classifies bedsores as “never events.” Thus, there are several arguments surrounding this type of event.
Practical Issues – The gist of the argument goes beyond healthcare management and into medical ethics and the bureaucracy of healthcare. Medicare Part A is hospital insurance that helps cover care in hospitals and skilled nursing facilities. In general, it covers inpatient care and inpatient rehabilitation costs. Medicare Part B covers medically necessary services: doctors’, medical equipment, home health care and services or supplies that treat a medical condition. Medicare Part D is specifically for Prescription Drug Coverage and once enrolled covers costs based on co-payments, a yearly deductible, the costs of the medication and the pharmacy used. In any case, the pharmaceuticals will be less expensive than they would be without coverage (Medicare.gov).
Further, there is not a great deal of research available on the timing it takes a pressure ulcer to appear. There are a number of factors that affect the issue: predisposition, actual health status, nutrition, severity of injury or surgery, pharmacological profile, weight/size/body dimensions, and more. Based on what research is available, findings indicate that pressure ulcers are likely to develop between the first hour and 4-6 hours after sustained loading onto the tissues (Gefen, 2008). Thus, in this case, it is more likely that the pressure ulcers developed after the patient was transferred to the hospital — but possible that the final day of care at the nursing facility contributed to the event. However, based on the charting that the skin sores were not noticeable for 24-48 hours, there is a higher probability that the patient did not receive enough preventative care at the hospital.
Ethical – The conundrum here is considerable; the patient is likely aged and on a fixed income based on information gleaned.: Within the framework of the ethical care model, we find that there are some medical ethical paradigms that would seem to say we prevent consternation for Mrs. Smith by recoding the infection so it will be covered: 1) Beneficence — At the core of medical ethics is the value of beneficence, which provides the primary goal and rationale of medicine and healthcare — the core of the Hippocratic Oath — “as to disease, make a habit of two things- help, or at least do no harm. 2) Veracity — In medical ethics, veracity is part of the relationship of trust between the healthcare professional and the patient. Honesty and truth in what the healthcare professional shares with the patient are now expected — and the relationship is reciprocal — the healthcare professional expects the patient to be honest and truthful about concerns, attitudes, and information regarding the physical or mental symptoms in question. The patient did not cause the infection, so why should they suffer? 3) Non-maleficence — The principle of non-maleficence not only asserts an obligation not to harm intentionally, but an additional obligation to use any and all appropriate treatments available to cure the illness. (Benjamin & Curtis, 2010).
Legal – Medicare will typically not pay or cover any “preventable” condition or mistake resulting from a hospital stay. In this patient’s case, they would not pay for the drugs, treatment, or extra days in care that were strictly based on the pressure sores. This was designed to make hospitals and healthcare facilities more accountable, but would inconvenience the patient (Medicare Will Not; 2007). Medicare and Medicaid specifically note that pressure sores will not be covered because they result in higher payments to the hospital even if the hospital caused the condition (Medicare Nonpayment, 2012).
Analysis- Based on the research, it does not appear that, in this case, there were strong predispositions toward pressure ulcers at the skilled care facility. Dehydration, however, could have contributed to the problem because if the tissues have no fluid, there is greater chance for abrasion. However, upon admittance to the hospital, we can only assume that they patient was given fluids. There is no mention, though, of the actual location of the sores or the protocol for turning the patient.
In this case it looks like the hospital will have to absorb the costs of the pressure ulcer care. The Administrator should immediately convene a committee to write standardized, best-practices, care sheet for potential pressure ulcer conditions. This would obviously focus on the elderly, and would require a protocol to prevent the sores, alleviate the causes (sheets, etc.), and if sores are noticed, aggressively treat them before they become serious. To make the situation more congenial and ultimately more meaningful to the potential future patient, the committee could be a joint group between the hospital and care facility — sharing knowledge and communication to strengthen the relationship and avoid unnecessary blame.
Coverage Information retrieved from http://www.medicare.gov
Medicare Nonpayment for Hospital Acquired Conditions. (2012). National Conference of State Legislatures. Retrieved from: http://www.ncsl.org/issues-research/health/medicare-nonpayment-for-hospital-acquired-conditio.aspx
Medicare Will Not Pay for Hospital Mistakes and Infections. (2007, August 20).
Medicalnewstoday. Retrieved from: http://www.medicalnewstoday.com/articles/80074.php
Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future. (2001).
Advanced Skin and Wound Care. 14 (4): 208-15.
Preventing and Treating Pressure Ulcers. (2009). UCan Health. Retrieved from:
Preventing Pressure Ulcers in Hospitals. (2011). Agency for Healthcare Research and Quality.
Retrieved from: http://www.ahrq.gov/research/ltc/pressureulcertoolkit/
Benjamin, M., & Curtis, J. (2010). Ethics in Nursing – Cases, Principles, reasoning. New York:
Gefen, A. (2008). How Much Time Does it Take to Get a Pressure Ulcer? Ostomy Wound
Management. 54 (10) 26-35. Retrieved from: http://www.o-wm.com/content/how-much-time-does-it-take-get-a-pressure-ulcer-integrated-evidence-human-animal-and-in-vitr
Meschino, J. (2011). Vitamin C — Ascorbic Acid. Meschino Health. Retrieved from:
Wound Ostomy and Continence Nurses Society. (March 24, 2009). Position Paper — Avoidable
versus Unavoidable Pressure Ulcers. Retrieved from: http://www.wocn.org/resource/resmgr/docs/wocn-avoidable-unavoidable_p.pdf
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
There is a very low likelihood that you won’t like the paper.
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.
You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.Read more
Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.Read more
Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.Read more
Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.Read more
By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.Read more