Yes, the issue is pressure sores, possibly the most uninteresting medical discussion to some of us in that it always represents a failure – something went wrong, either on the part of the patient or the family or the medical team. It is very different from most of the diseases and conditions we deal with from the exotic zebras to the complex illnesses. It’s just not glitzy or a highlight subject of our medical discussions, and most of us have zero training (or less) in our didactic education about this. And it also just doesn’t get better quickly enough to see the results of our efforts in a hospital turn-around average-3-day-length-of-stay type environment we all live in – and it and never looks pretty. Most of us try not to think about it much.
But we have to.
Pressure sores are now a super, mega really big deal – actually more important than this hyperbole would suggest. First, we are just not doing our best to keep them from developing in our inpatients, or getting worse from their initial state. Yes we do a great job in most cases, but too many times our care and prevention fail our patients. We need to do this a lot better. To learn more, refer to the Power Point presentation on our website prepared by Dr. Lee Ruotsi, the Medical Director of the CHS Advanced Wound Healing Programs. There is a lot of great information there, including state of the art updates.
Second, an equally ominous concern is our documentation. We have 2 areas here where our pen (now called a keyboard) is no longer mightier than our sword (now called a scalpel). Or maybe our pen is too mighty, and cutting us up before the sword even has a chance. We are simply not using our pen the right way. Our first recording issue is in documenting, describing, and staging our pressure sores correctly. This documentation is essential and needs to be consistent, clear, and follow national standards and guidelines. These are very well described in Lee’s presentation, and everyone who sees inpatients needs to be familiar with this information. However, our description still relies on our eyes, more specifically our physical examination. Yes, even with EHR demands and requirements, we have to examine our patients thoroughly. Perhaps the echocardiogram will tell us more about cardiac function than our stethoscope (debatable and controversial), but nothing will replace a meticulous skin exam including looking under the rug to look carefully for all pressure sores wherever they may be lurking.
The other documentation area is POA (present on admission). Simply if a pressure sore is already there when a patient is admitted, but the physician fails to document – or documents inadequately – that it is present then you are automatically GUILY AS CHARGED – meaning that you (doctor, nurses, hospital as a team) caused the pressure sore and will go to quality jail. This means both profound financial penalties as well as being targeted for poor quality of care. Instead of the guilty proclaiming their innocence, this becomes the innocent making themselves guilty of a serious crime they did not complete. Cheryl Friedman also has included a great summary of what POA really means, and how to use it, on our website. No one else who does documentation in the chart counts with respect to documenting pressure sores except the provider. The ball is completely in our court.
Lessons:
1. Don’t get sore
2. Don’t plead guilty when you are innocent
3. Continue taking excellent care of all of our patients
