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I'm not surprised to learn that the incidence of pressure ulcers has increased dramatically from 1993 to 2006 (Clinical Rounds, "Pressure Ulcers: Incidence Increased 80% Over 13 Years," March 2009.)* With recent technologic advances, patients with chronic debilitating diseases that leave them bedridden are being kept alive longer. Meanwhile, nurses and assistive staff are expected to do more with fewer and fewer resources.


In the same issue, nurses responded to a question about repositioning. (Clinical Rounds: "Survey Responses: Preventing Pressure Ulcers: Do You Reposition Patients Every 2 Hours?")* Even though 92% of survey respondents said they turn patients every 2 hours, your commentary notes that "those with fragile skin or little subcutaneous tissue should be repositioned more frequently." Many patients who fall into that category have multiple contractures that inhibit optimal positioning.


Staffing cuts in long-term-care facilities as well as in acute care hospitals decrease the number of personnel available to turn and reposition patients appropriately. Preventive measures such as specialty beds with features designed to relieve pressure may not be reimbursed or are reimbursed only after the patient has already developed a pressure ulcer.


Until third party payers become more willing to pay for preventive measures and administrative "bean-counters" realize that cutting staffing to the bone isn't cost-effective, the problem will continue.




Natchitoches, La.


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