Our Industry

Pressure ulcers, or bedsores, can cause great pain to patients in hospitals or residential care and great distress for families of those patients, often resulting in lawsuits. To address this serious problem, Fox participated in developing a quality improvement system called AIM. In cooperation with the Institute for Elder Care Agency for Healthcare Research and Quality (AHRQ), Fox validated the AIM system, which is centered on training with Fox modules, and demonstrated the ability to reduce reduced the incidence of pressure ulcers by 75%.

See the Problem

The Problem

Pressure ulcers in nursing homes and hospitals affect more than 1,000,000 people annually at a cost of 1,600,00,00 (Medicare, private insurance industry, significant un-reimbursed costs for the nursing homes and hospitals).
Pain and distress for patients and families resulting in lawsuits.

Solution

Fox Learning Systems and the Institute for Eldercare Education can reduce the incidence of pressure ulcers using a cost effective, and scientifically tested Quality Improvement Process called the AIM System.

From the Experts

"The average hospital incurs $400,000 to $700,000 in direct costs to treat pressure ulcers annually. Most of that cost is not reimbursable. It is estimated that 20 minutes/day/patient of nursing time is related to services for pressure ulcers." Robinson C, et al., "Determining the efficacy of a pressure ulcer prevention program by collecting prevalence and incidence data: A unit-based effort." Ostomy/Wound Management . May 2003; 49(5):44-51.
"Pressure ulcers are estimated to affect 1 million people each year, leading to an annual cost of approximately $1.6 billion." Whittington K, Patrick M, and Roberts JL, "A National study of pressure ulcer prevalence and incidence in acute care hospitals," Journal of Wound, Ostomy and Continence Nursing. July 2000; 27(4):209-215.
"The cost to heal a complex, full-thickness PU may run as much as $70,000; the cost of a less serious PU may range from $2000 to 30,000." Amlung SA, Miller WL, and Bosley LM, "The 1999 National Pressure Ulcer Prevalence Survey: A benchmarking approach," Advances in Skin & Wound Care. November/December 2001:297-301.
"Most recently, the U.S. Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) included pressure ulcers as one of three sentinel events for long-term care; therefore, the formation of a pressure ulcer or subsequent deterioration of a pressure ulcer can lead to significant monetary penalties (maximum $10,000/day) in long-term care." Lyder CH, et al., "A comprehensive program to prevent pressure ulcers in long-term care: Exploring costs and outcomes, " International Journal of Quality Health Care. February 1996;8(1):61-66.

See the Solution

Skin Care / Preventions of Pressure Ulcers

Understand importance of skin
Identify how skin changes with age
Develop strategies for preventing and treating skin damage and pressure ulcers

Staging of Pressure Ulcers

Stage 1 - Skin color and texture changes: reversible if detected.
Stage 2 - Blister: tissue damage occurs
Stage 3 - Crater: more extensive damage
Stage 4 - Open wound down to the bone: severe damage often needing surgery

See the Benefits

All staff can be trained using Fox Learning System's Solutions for Long Term Care interactive multi-media video system in 30 days.
Approximately 30-40 minutes per staff
Can be completed in group training or individually
Integrated database provides management feedback regarding adherence to protocol and competency
Comprehensive administrators workbook provide a day-by-day game plan
Week-by-week measures real-time tangible progress showing progress towards goals are provided
Incorporates all required system hardware, software, management materials, and training/technical support services

AIM Method of Quality Improvement

A = Ability - Universal training for all staff using Solutions for Long Term Care.
I = Incentives - Fraction of financial savings achieved by successful QI.
M = Management Feedback - Real-time feedback for management's response is essential (managers use combination of positive and negative reinforcement).

AIM to Prevent Pressure Ulcers*

150 bed facility
Pre-intervention: 53 pressure ulcers among 29 residents (26%) in 3 months
Intervention using the AIM System: reduced to 11 pressure ulcers among 10 residents (9%) in 3 months
100% adherence to protocol by staff
All staff received financial incentive
At estimate of $3,000 per ulcer, financial savings greater than $100,000 over 3 months

*Presented at AHRQ Patient Safety Conference (September 22, 2004)

Prevention of Ulcers

90% of pressure ulcers can be prevented by proper nursing care.

Skin must be kept clean and dry
Patients must be re-positioned every 2 hours
Adequate nutrition and hydration