Just how much of an impact do wound care certified (WCC) nurses and other clinicians have on their patients? More than you might imagine.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

A formal study was conducted under the auspices of a Centers for Medicare and Medicaid Services (CMS) program known as the Hospital Improvement Innovation Network (HIIN). The findings of the study revealed a correlation with the presence of onsite WCC staff and a reduction in pressure injury rates for patients.

More than 2.5 million people in the U.S. are affected by pressure injuries, and more than 60,000 patients die each year as a direct result of the condition, according to the Agency for Healthcare Research and Quality.

The HIIN study was funded by a grant program through the CMS using civil monetary penalty funds. These funds are used to support projects that benefit patients and residents of nursing homes with the goal of improving the quality of care they receive.

“The Ohio Department of Medicaid manages the grant process and money in Ohio for CMS,” said Mandy Smith, CEAL, LNHA, LMT, LPTA, RAC-CT, WCC, regulatory director with the Ohio Health Care Association in Lewis Center, Ohio. “It requires approval through both the Ohio Department of Medicaid and then CMS. Additionally, the Ohio Health Care Association contributed our time and staff, who were involved in the collection and analysis of data for the study.”

Pressure injury research process

Research formally started following a 2016 Wound Care Education Institute (WCEI) Skin and Wound Care Management training of nearly 200 long-term care nurses in Ohio. The training was part of a joint venture with the Ohio Health Care Association and the Ohio Department of Medicaid.

The purpose of providing this training was to see if quality measures related to pressure injury rates improved, as evidenced by a decrease in pressure injury rates for patients residing in skilled nursing facilities that employed WCC nurses.

A total of 199 nurses attended the face-to-face, five-day wound care certification course, and subsequently took the WCC certification exam offered by the credentialing board — the National Alliance of Wound Care and Ostomy.

In all, 140 nurses — 70% — passed the exam and became certified, according to John LeDell, CWCMS, client executive with WCEI, a Relias healthcare company.

Study reveals positive pressure injury outcomes

Once the training and examination process were complete, the study began and used fourth quarter 2016 as the baseline, followed by tracking high-risk pressure injury rates at Ohio skilled nursing facilities involved in the study, LeDell said.

“In addition to monitoring pressure injury rates, the other data collected on a routine basis was to confirm if the WCC nurse was still employed at each facility involved in the study,” he said. “The tracking and reporting of data were done by the Ohio Health Care Association, and results were reported to the Ohio Department of Medicaid.”

Also included as part of the study and analysis process was the division of the skilled nursing facilities by their level of performance at baseline.

The Ohio Health Care Association divided the facilities involved in the study into two different groups, group A and group B.

  • Group A facilities were those performing in the bottom 25% of pressure injury rates at baseline.
  • Group B facilities were those performing in the top 75% of pressure injury rates.

In the end, the study revealed the reduction in high-risk pressure injury rates was significant for facilities that had WCC staff, according to data compiled by the Ohio Health Care Association and reported to the Ohio Department of Medicaid.

  • At baseline, Group A facilities had an 11.4% pressure injury rate in 2016, and saw that rate drop to 7% in 2017 — an improvement of more than 4%.
  • Group B facilities that were already high performers with their quality measures, initially had a pressure injury rate of 3.61% in 2016, and saw their rate drop down even further to 3.2% in 2017.

Even more dramatic is the data for Group A when comparing the baseline rate in 2016 to 2018. Group A went from their starting rate of 11.4% in 2016 and dropped to 2.44% in 2018 — close to a 9% drop.

Group B’s decrease was less when comparing the same time frame, going from their baseline of 3.61% in 2016 and ending at 3.45% in 2018, according to the final analysis performed by the Ohio Health Care Association and reported to the Ohio Department of Medicaid.

Reducing pressure injuries decreases costs

Reducing pressure injury rates comes with significant cost savings. Research shows that an individual organization that prevents even just one stage 3 or stage 4 pressure injury would save $20,000 in direct costs or up to $120,000 in total cost.

The average hospital treatment cost associated with stage IV pressure injuries and related complications was $129,248 for hospital-acquired ulcers during one admission, and $124,327 for community-acquired ulcers over an average of four admissions.

Pressure injuries cost $9.1 to $11.6 billion per year in the U.S., with the cost of individual patient care ranging from $20,900 to $151,700 per pressure injury.

Medicare estimated in 2007 that each pressure injury added $43,180 in costs to a hospital stay, according to the Agency for Healthcare Research and Quality.

“In a vast majority of cases, pressure injuries are avoidable with the appropriate care,” said Bob Applebaum, PhD, director of the Ohio Long-Term Care Research Project, professor in the Department of Sociology and Gerontology and a Scripps Research Fellow at Miami University. “The results of this study are encouraging and a good first step as a pilot program on the topic.”

Learn more about pressure injury rates in our Skin and Wound Care Management course.

Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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