Secondary analysis of office of inspector general's pressure ulcer data: incidence, avoidability, and level of harm.
OBJECTIVE
To provide information about a secondary analysis of pressure ulcer data regarding incidence, avoidability, and level of harm.


BACKGROUND
This continuing activity is intended for physicians and nurses with an interest in skin and wound care.


OBJECTIVE
After participating in this educational activity, the participant should be better able to:1. Summarize the data provided in the Office of Inspector General (OIG) study regarding incidence of pressure ulcers (PrUs) found in hospitals and skilled nursing facilities (SNFs).2. Identify the classification systems used that designate levels of harm to patients and the avoidability of PrUs.


OBJECTIVE
To investigate in greater detail the government data on pressure ulcer (PrU) incidence, avoidability, and level of harm.


METHODS
The authors performed a secondary analysis of PrU data published in 2 studies by the Office of Inspector General (OIG) on adverse events in hospitals and skilled nursing facilities (SNFs).


METHODS
Acute care hospitals and Medicare-certified SNFs across the United States.


METHODS
The hospital sample included 780 Medicare beneficiaries randomly selected from 999,645 discharges during October 2008. The SNF population included 653 Medicare beneficiaries randomly selected from 100,771 patients whose stay began within 1 day of hospital discharge, who had a length of stay of 35 days or less, and whose stay ended in August 2011.


METHODS
Pressure ulcer incidence with stage, location, avoidability, and level of harm using the Modified National Coordinating Council for Medication Errors Reporting and Prevention Index.


RESULTS
The PrU incidence in hospitals was 2.9%, and the incidence in SNFs was 3.4%. Most PrUs were Stages I and II, with 78.3% in hospitals and 54.5% in SNFs. The avoidability of PrUs was similar in both locations, with 39.1% unavoidable in hospitals and 40.9% unavoidable in SNFs. All hospital-acquired PrUs and 90.9% of SNF-acquired PrUs were designated level E on the National Coordinating Council for Medication Errors Reporting and Prevention Index, indicating a temporary harm event.


CONCLUSIONS
The OIG studies captured few Stage III PrUs and no Stage IV PrUs, and they underestimate the level of harm generated from PrUs in hospitals and SNFs. The studies offer a structured algorithm for avoidability determination, but lack measures of reliability and validity. Nonetheless, the high rate of unavoidable ulcers leads to questions on the reliability of PrUs as a quality indicator. There are several weaknesses in OIG methodology with regard to PrUs; however, its structured algorithm can be viewed as a starting point for future studies of PrU avoidability.
Jeffrey M. Levine, MD, AGSF, CWSP • Attending Physician • Mount Sinai Beth Israel Medical Center and Icahn School of Medicine at Mount Sinai • New York, New York Karen M. Zulkowski, DNS, RN • Associate Professor • Montana State University • Bozeman, Montana.
Jeffrey M
JM
Levine
Karen M
KM
Zulkowski
D006801:Humans; D015994:Incidence; D006278:Medicare; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control*; D058996:Quality Improvement; D011787:Quality of Health Care; D011897:Random Allocation; D014481:United States / Q000453:epidemiology