title: Establishing a comprehensive networkwide pressure ulcer identification process.
abstract: BACKGROUND
  Pressure ulcers (PUs) are a critical concern, endangering patients and requiring significant resources for treatment in Stage II/IV. The Centers for Medicare & Medicaid Services (CMS) denies reimbursement in cases where a more complex diagnosis-related group (DRG) is assigned as a result of hospital-acquired conditions such as a PU that could have been reasonably prevented.
  
  
  METHODS
  An interdisciplinary PU present-on-admission (POA) team developed an algorithm to support the early identification of PUs for units participating in the process. This approach standardized work, resulting in consistent (1) skin assessment, (2) physician notification, (3) reporting of findings in the patient safety reporting system, and (4) communication to receiving units. Computer-entry tools were developed and completed for six months by the patient care services unit-based process improvement councils; these councils made possible immediate "loop closure" for either positive feedback or needed reeducation with the nursing staff.
  
  
  RESULTS
  The total number of PUs recognized and reported after implementation of the process improvement initiative--from April 1, 2008, to March 31, 2009--increased to 1,103--an increase of 36.3% in PU reporting when compared with the same period the year before. This initiative has yielded 100% effectiveness in identifying Stage III/IV PUs POA and in preventing hospital-acquired Stage III/IV PUs. The success of the project has helped to ensure high-quality patient care and protection of precious fiscal resources.
  
  
  CONCLUSIONS
  The data suggest that the identification of all PUs that are present at time of admission is clinically feasible.
authors.affiliation: Patient Care Services, Lehigh Valley Health Network, Allentown, Pennsylvania, USA. Courtney.Vose@lvh.com
authors.forename: Courtney
authors.initials: C
authors.lastname: Vose
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
authors.forename: David B
authors.initials: DB
authors.lastname: Burmeister
authors.forename: Charlotte
authors.initials: C
authors.lastname: Buckenmyer
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Davidson
authors.forename: Tami J
authors.initials: TJ
authors.lastname: Meltsch
authors.forename: Ginger
authors.initials: G
authors.lastname: Holko
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Karoly
authors.forename: Bernadette Glenn
authors.initials: BG
authors.lastname: Porter
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D004282:Documentation; D019983:Guideline Adherence / Q000592:standards; D006265:Health Care Coalitions / Q000458:organization & administration*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000592:standards; D008403:Mass Screening / Q000592:standards / Q000639:trends; D010343:Patient Admission / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D010414:Pennsylvania; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D014481:United States