Strategies for Managing Incontinence Challenges and Related Wound Care Management

1
Strategies for Managing Incontinence Challenges
and Related Wound Care Management

• Presented by Steve Salomon, RN, MBA
• Principle Business Enterprises, Inc.
• NASVH Winter Conference 2012

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Objectives

• Identify trends in patient population for
  incontinence issues including obesity
• Understand new regulatory guidelines Present on
  Admission (POA)
• Impact of new regulations Present on Admission
  (Acute Care) as what this means for LTC
• Understand how Incontinence can impact wound
  care/ skin care/ slips and falls
• Address new clinical studies to use when
  implementing an incontinence program and looking
  at how product selection can impact quality of
  care.
• Understand related costs of care when dealing
  with a patient with incontinence

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Growth in Aging Population
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Obesity Trends Among U.S. AdultsBRFSS, 1990,
1998, 2007
(BMI ?30, or about 30 lbs. overweight for 54
person)
1998
1990
2007
No Data lt10 1014
1519 2024 2529
30
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Overweight and obesity are known risk factors
for

• diabetes
• coronary heart disease
• high blood cholesterol
• stroke
• hypertension
• gallbladder disease
• osteoarthritis (degeneration of cartilage and
  bone of joints)
• sleep apnea and other breathing problems
• some forms of cancer (breast, colorectal,
  endometrial, and kidney)
• Obesity is also
  associated with
• stress incontinence (urine leakage caused by weak
  pelvic floor muscles)
• psychological disorders, such as depression
• increased surgical risk
• increased mortality

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Wound Care/ Present on Admission (POA)
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POA Indicator General Requirements

• Present on admission (POA) is defined as present
  at the time the order for inpatient admission
  occurs
• Conditions that develop during an outpatient
  encounter, including emergency department,
  observation, or outpatient surgery, are
  considered POA
• POA indicator is assigned to
• Principal diagnosis
• Secondary diagnoses
• External cause of injury codes (Medicare requires
  reporting only if E-code is reported as an
  additional diagnosis)

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Present on Admission
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Wound CareF-Tag 314
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Intent of Tag F314

• Predicated on the LTC facility providing adequate
  care and services to
• Promote the prevention of pressure ulcer
  development
• Promote the healing of pressure ulcers that are
  present
• Prevent development of additional pressure ulcers
• A paper trail can follow intent

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The Bottom Line.

• The care process should include efforts to
  stabilize, reduce or remove underlying risk
  factors
• To monitor the impact of the interventions
• To modify the interventions as appropriate.
• CMS Guidelines

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F-Tag 314 Assessment

• Prompt admission evaluation helps identify
• The resident at risk of developing a pressure
  ulcer
• The resident with existing pressure ulcers
• Areas of skin at risk for skin breakdown
• Pre-existing signs of deep tissue damage

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F-Tag 314 Assessment

• Deep Tissue Injury
• Purple or very dark areas that are surrounded by
  profound redness, edema, or induration suggest
  that deep tissue damage has already occurred and
  additional deep tissue loss may occur.

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F-Tag 314 Factors that increase
susceptibility to develop or not heal pressure
ulcers

• A healed ulcer
• History of a healed ulcer is important.
• Areas of healed Stage III or IV pressure ulcers
  are more likely to have recurrent breakdown.

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Assess Nutrition Status
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Prevention

• Place at risk individuals on a pressure reduction
  surface
• Reduce pressure for chair-bound individuals
• Gel or air is more effective than foam
• Relieve pressure under heels using pillows or
  other devices
• Use incontinence skin barriers

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Treatment of Pressure Ulcers

• Reduce friction and shear
• Reduce/relieve pressure
• Low air loss/air fluidized may improve healing
  rates
• Shift immobile patients in chair every hour and
  limit out of bed time
• Ensure adequate nutritional and fluid intake
• Product selection is critical

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Summary

• Employ Standards of Care
• Communicate to residents, providers, family
• Demonstrate competency
• Treat underlying etiology
• If patient fails 2-4 weeks therapy, consider
  referral
• Prevention is key reduce mechanical forces,
  ensure adequate nutrition and hydration
• Keep educated on products

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IncontinenceF-Tag 315
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(No Transcript)
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Why did CMS revise the standards ?
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F Tag 315 Requirements
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Understand how Incontinence can impact wound
care/ skin care/ slips and falls and related risk
management
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Incontinenceand its Impact on Wound Care

• Urinary incontinence affects 38 of women
  and 17 of men age 60 and older. Perineal skin
  damage secondary to incontinence has been
  reported to occur in 31 of acute care patients
  and 41 of long-term care patients. Perineal
  dermatitis has been reported to increase risk for
  UTIs, microbial skin infections, and pressure
  ulcers. Fecal incontinence has been documented
  as one of the most common risk factors for
  pressure ulcer development.

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Slips and Falls
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Slips and Falls

• According to the American Academy of
  Orthopedic Surgeons
• 30 of all people over the age of 65 fall each
  year.
• 50 of older adults hospitalized with a hip
  fracture are unable to return home or live
  independently again.
•       

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Slips and Falls

• In 2003, 1.5 million people 65 and older lived in
  nursing homes. If current rates continue, by 2030
  this number will rise to about 3 million.
• About 5 of adults 65 and older live in nursing
  homes, but nursing home residents account for
  about 20 of deaths from falls in this age group.
  
• Each year, a typical nursing home with 100 beds
  reports 100 to 200 falls. Many falls go
  unreported.
• As many as 3 out of 4 nursing home residents fall
  each year. Thats twice the rate of falls for
  older adults living in the community.
• Patients often fall more than once. The average
  is 2.6 falls per person per year.
• About 35 of fall injuries occur among residents
  who cannot walk.

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Prevent Falls with a good Exercise Program.
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Slips and Falls


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Understand related costs of care when dealing
with a patient with incontinence and its impact
on wound care
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Cost of Care
of the population with UI OAB
Over 200 Million dollars in expense due to Skin
Irritation, UTI and Falls because of UI and OAB
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Address new clinical studies to use when
implementing an incontinence program and looking
at how product selection can impact quality of
care
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Associated costs of careThe Iceberg Theory

• Dressings/ Tape ?
• Gloves ?
• Skin Breakdown ?
• Creams/ Lotions ?
• Pain Medications ?
• Sleep Medications ?
• Reporting/ Legal ?
• Physician/ Hospital ?
• Rest/ Sleep through the night ?
• Patient Dignity ?
• Caregiver time ?
• Product Cost/ Frequency of Care
• Linen and Trash ?

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Linking Incontinence with Wound Care

• New studies completed
• New studies in progress
• Collaboration between wound and skin care
  clinicians

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Looking at Skin Barrier Function
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Objectives

• Identify trends in patient population for
  incontinence issues including obesity
• Understand new regulatory guidelines Present on
  Admission (POA)
• Impact of new regulations Present on Admission
  (Acute Care) as what this means for LTC
• Understand how Incontinence can impact wound
  care/ skin care/ slips and falls
• Address new clinical studies to use when
  implementing an incontinence program and looking
  at how product selection can impact quality of
  care.
• Understand related costs of care when dealing
  with a patient with incontinence

37
Contact Information

• Steve Salomon, RN, MBA
• 305 South Ladd Court
• Daniel Island, SC 29492
• 843-737-1053
• ssalomon_at_pbenet.com