- The burden of chronic wounds continues to grow with an aging population.
- One reason pressure wounds hold such significance in tracking care is that they are considered “never events.”
- These are “serious, largely preventable, and harmful clinical events,” as defined by the National Quality Forum.
If you have treated patients with non-pressure wounds before, you know how challenging the situations can be. Chronic wounds are of growing concern, and, as a result, the healthcare industry also has a growing need for skilled wound care physicians.
The Wound Healing Society classifies chronic wounds into four categories:
- Diabetic Foot Ulcers
- Arterial Ulcers
- Venous Ulcers
- Pressure Ulcers
Despite the fact that there are more non-pressure chronic wounds than pressure wounds, pressure ulcers often receive the highest priority with regulators, totaling a greater number of civil lawsuits.
Incidence of Chronic Wounds
The burden of chronic wounds continues to grow with an aging population. In 2009, it was estimated 6.5 million people had a chronic wound, with a $25 billion annual price tag on treatment. By 2018, the number with a chronic wound rose to 8.2 million people, all of whom were Medicare beneficiaries, adding up to an annual cost of $96.8 billion – this estimate is limited to only people on Medicare and misses younger individuals, older adults with private insurance, and the uninsured.
Pressure ulcers have had the highest priority in long-term care for a variety of reasons. They’re a significant risk factor for morbidity and mortality and are a high risk for litigation. The Centers for Medicare and Medicaid Services track these wounds carefully using Minimum Data Set (MDS) reporting, and they’re a marker of quality the CMS uses in its 5-star rating system.
One reason pressure wounds hold such significance in tracking care is that they are considered “never events.” These are “serious, largely preventable, and harmful clinical events,” as defined by the National Quality Forum. This results in time, focus, and energy placed on preventing adverse events that are preventable, while sometimes negating the importance of non-pressure chronic wounds resulting from medical conditions, trauma, or surgery.
Origin and Identification of Non-Pressure Wounds
As a whole, non-pressure wounds happen more often than pressure wounds. Some of the most common non-pressure wounds are diabetic, arterial, venous, and other wounds caused by trauma. Less frequent wounds are caused by lymphedema, burns, post-surgical tissue, neoplasms, and autoimmune conditions.
With less attention and focus, many non-pressure wounds are also less understood. General awareness by long-term care facilities cast the greater focus on pressure wounds. However, non-pressure wounds are often more complex and require a higher level of training and skill to properly diagnose and treat.
Proper treatment for non-pressure wounds is dependent on proper identification. Many arterial and venous ulcers are typically found in the lower extremities, and differentiating between the two can be challenging. Since they have different pathophysiology and management protocols, identification is necessary, and, in fact, vital to the healing process.
Arterial ulcers are the result of poor blood supply, which can be secondary to diabetes, trauma, or peripheral vascular disease. Venous ulcers are secondary to an incompetent venous valve, from a deep vein thrombosis, obesity, age, or a failed calf pump. Mixed arterial and venous insufficiency occurs in approximately 7% of all lower leg ulcers. While diabetic ulcers are often found at pressure points at the bottom of the feet, they are neurotrophic in origin, and are often related to trauma in individuals who have impaired sensation in the lower extremities.
Challenges with Non-Pressure Wounds
The challenge with non-pressure wounds is that they usually require special expertise in management, and often from a multidisciplinary team. For example, data from the National Health Service (NHS) in Scotland shows that venous leg ulcers account for over 90% of all people presenting with a lower extremity ulcer. Proper treatment is essential, as improper diagnosis and application of compression dressings can have dramatic and drastic consequences, sometimes even resulting in the loss of the limb.
The success rate is considerably higher when physicians are available who can properly diagnose a venous ulcer and confirm there is adequate arterial flow. It’s also essential to have nurses skilled in the application of compression dressings. This is just one example of a non-pressure wound that presents significant challenges to long-term care facilities that may not be staffed with certified wound care nurses, or those that have access to physicians who can appropriately diagnose and prescribe interventions for a unique set of wounds.
How to Fill Gaps in Care and Improve Patient Outcomes
Statistics from the Centers for Disease Control and Prevention (CDC) show there were 15,600 nursing homes in the US in 2016. In those, there were 1.7 million licensed beds and 1.3 million residents. People in long-term care facilities can be vulnerable to a greater number of safety problems and are chronically ill at disproportionate rates compared to the general population.
Long-term care facilities sometimes care for medically-complex patients, providing services with the expectation of quality care. Yet, in 2014, a report from the office of the Inspector General found 22% of Medicare beneficiaries in skilled nursing facilities had experienced at least one adverse event, and more than half of those were preventable.
Addressing patient safety and outcomes is crucial to patient care and reimbursement for long-term care facilities. The wide range of wound etiologies necessitates a comprehensive care team which is well-coordinated, and led by a physician with a specialization in wound care. As research has shown, this is the ideal model to improve patient outcomes and reduce penalties to long-term care facilities.
In fact, a wound care team approach has demonstrated the ability to reduce wound healing by an average of 21 days, while reducing Medicare costs as well. A certified wound care nurse is integral to the success of any team in patient care. When the next level of knowledge, training, and skill is lacking, prevention, diagnosis, and proper treatment are bound to fail.
However, with the right, specialized team, you can offer your patients the best in wound care, and treat non-pressure wounds and other chronic wounds with the utmost expertise.