Pressure Injuries Still a Nagging Problem for Injured Workers

WorkersCompensation.com
Full article on WorkersCompensation.com
By: Nancy Grover

Sarasota, FL (WorkersCompensation.com) – Wounds can be a major cost driver in workers’ compensation claims. The costs to treat these pressure injuries can quickly and easily run up to $100,000 or more, especially if an injured worker must be hospitalized or develops complications such as infections.

An estimated 2.5 million individuals in the U.S. develop pressure injuries annually, at a cost of $26 billion. The problem has persisted for years, despite concerted efforts to prevent and reduce the effects of pressure injuries.

“Statistics show that wounds from 2014 to 2017 increased by 6 percent,” said Edwina Murphy, medical director of Rehab Technology for ATF Medical. “Even though everybody’s trying – we’re making this huge push to get control of them – the incidents are still climbing.”

Experts say there are emerging technologies that can help. Beyond that, educating everyone involved in a claim and ensuring all are on the same page can make a tremendous difference in addressing these injuries.

The Issue
Pressure injuries develop for a variety of reasons. Trauma, certain medications which may degrade the skin, and poor diet, for example. They can also occur due to lack of movement, which is especially concerning for injured workers with catastrophic injuries who are kept immobile.

“One of the areas we see is during acute care,” said Lisa Farrell-Roberts, senior director of Clinical Solutions at Paradigm. “It’s not uncommon when people sometimes develop horrific wounds when in the ICU, or not in the right place. I’m talking about the hospital they are in [with] maybe not the most skilled people in wound care. They can get tremendous wounds that require DIEP flap grafts, stretching-to-sitting programs. That area will be vulnerable for the rest of their lives.”

It doesn’t help that many injured workers have comorbidities. For example, someone with diabetes who’s had a successful amputation may then suffer from their skin breaking down when they try to wear a prothesis.

“They are impaired, [have lost] sensation and mobility – and are diabetic,” Farrell-Roberts said. “Risk of skin breakdown is very significant in the spinal cord population.”

The Costs
Putting a pricetag on pressure injuries is difficult, as each person is different.

A vacuum-assisted closure of a wound – wound vac – is one treatment that can help those with severe pressure injuries. They can be very effective in the healing process by decreasing inflammation, pulling the skin together, and taking out bacteria. However, they cost around $30,000 to purchase, or around $8,000 to rent one for a month.

A nurse sent to the injured worker’s home to help typically comes twice a week for eight weeks – at a cost of $125 per day. If an infection develops, medication used over an eight-week period can cost over $28,000.

Durable medical equipment can also be expensive. Adding in the prices of a hospital stay and rehab can dramatically drive up the cost of a pressure injury.

“So, there you are looking at a $50,000 wheelchair. Often a new bed with a specialty mattress – some can be $20,000,” said Amy Meltzer, director of Clinical Solutions at Paradigm. “The wound care supplies can be quite expensive themselves, depending on what they are. Fetal tissue may be used and those types of grafts – it looks like a piece of Kleenex on a wound but they are quite expensive and it usually takes multiple applications. There are different procedures for treating wounds; weekly visits to facilities, and transportation. It can be very expensive.”

Lack of Coordination
One of the reasons pressure injuries continue to endure and even increase is due to the failure of coordination among many stakeholders. For example, protocol dictates that patients be asked a number of questions related to pressure injuries when they are admitted to a hospital and nurses are expected to do a wound and skin check. Those at high risk are supposed to be identified as such.

“There is a large body of information, from credible nursing, rehabilitation and equipment manufacturers about pressure injuries, but it is not all in one place and not customized to the individual and circulated to all the providers who need it,” Murphy said. “Research shows the implementation of protocols was being interpreted differently from one [hospital] floor to the next.”

In home settings the problem can be worse, with a lack of consistency and forgetfulness on the part of caregivers.

“People start out with good intentions but don’t follow through, a week later, or a month later,” Murphy said. “They lack communication between different entities involved. That’s a problem at hospitals as well and differences implementing [the protocols] from one floor to another floor; from the orthopedic floor, to the amputee floor, to the oncology floor – each implementation is different.”

Finally, a lack of knowledge – on the part of the caregiver and the injured worker – is cited as another major reason for the development and worsening of pressure injuries.

Solutions
Transitioning from a hospital to the home is a key point to prevent pressure injuries from developing or becoming worse.

“When they are in the hospital they are a captive audience … But when they transition home, and their skin is intact, that becomes another critical point because they had been surrounded by a healthcare team and had lots of eyes looking,” Farrell-Roberts said. “So making sure during that transition they have the knowledge they need, that they get it, [along with] anybody involved; the attendant, nurse, family – that they understand it too. I see that as a really vulnerable time … people are so darned happy to get home and that honeymoon can end quickly by something like skin breakdown.”

Part of educating injured workers and their families is providing emotional support. When they are finally out of the hospital they probably don’t want to think about their skin so much.

“They think, ‘nothing worse can happen to me,’” Farrell-Roberts said. “Well, it can.”

A new technology may help injured workers with pressure injuries take ownership over their treatment. Called Pressure Injury Preventing and Intervention (PIPI) and introduced by ATF Medical, it uses pressure mapping to detect pressure points.

The treatment is basically a thin map with sensors inside that measure pressure and tells the user how his pressure is being distributed while sitting or lying down. Once there is too much pressure on a certain area, blood stops flowing. If that occurs for more than 20 minutes a chemical reaction ensues in the body and tissue starts dying. The ‘map’ is color coded, with blue to red. When intense pressure is detected, the user sees the color turn red.

“Pressure mapping helps identify a seat or mattress issue, often something that can be easily and inexpensively adjusted,” Murphy explained. “When injured people can see how relieving pressure affects the colors on the map, they’re more apt to comply with relief techniques and other self-management guidance.

“It’s an educational tool. It shows you while you are sitting or lying what is going on with your pressures.”

If the map turns red, the user must be sure to change positions after 20 minutes.

“It really gets the person to buy into the pressuring-relieving part of the programs,” Murphy said. “It’s only one part of the treatment for wound care, getting the person to buy into that. You need to be aware of blood flow. This color thing helps you understand that.

“My goal for my company is to identify very early on people who are high risk and make sure they have all the tools and that everybody involved in that team – the injured worker himself, the caregivers – family member or hired paid person, the nurse who comes in to treat the wounds, the wound care center if the client is going to one – everybody has all the information they need.”