Pressure Ulcers
The Institute for the Future of Aging Services, Washington, DC, the research arm of the American Association of Homes and Services for the Aging (AAHSA), is inviting long-term-care facilities to participate in a 4-year applied research project to reduce the risk of pressure ulcers. The project is one in a series of "Partnerships for Quality" initiatives being funded by the federal Agency for Healthcare Research and Quality.
The institute and its project partner, the Institute for Clinical Outcomes Research of Salt Lake City, say that implementing research findings in long-term-care settings, using automated, standardized data collection forms and information technology tools, will accelerate the adoption of best practices shown to improve the quality of care.
The goal is to provide information to caregivers at the point of care, or during care planning, to facilitate decisions based on best practices. The standardized, automated documentation format lists the physical assessment triggers for pressure ulcers side by side with the appropriate intervention for each trigger. Presently, assessment information is often scattered among multiple forms, obscuring the full picture of a resident's risk. Using a standardized format that can be scanned or entered directly into software greatly reduces redundant data entry and the risk of errors in copying data from one form to another.
According to Susan D. Horn, PhD, senior scientist at the Institute for Clinical Outcomes Research, and member of the Advances in Skin & Wound Care Editorial Advisory Board, "Using new tools that introduce evidence-based care protocols into daily resident assessment will enable optimal care planning and result in better resident outcomes, less suffering, and greater professional satisfaction for caregivers. Everyone will win."
For more information, interested facilities should contact Dr Horn at 801-466-5595, ext 125; or E-mail, [email protected].
Diabetic Foot Ulcers
Bone structure abnormalities and impaired foot and ankle biomechanics in patients with diabetes are key risk factors for development of ulcers in the great toe area, according to research reported in the November/December 2002 issue of the Journal of Foot and Ankle Surgery.
The study's lead author, Troy J. Boffeli, DPM, FACFAS, chief of podiatry services, Regions Hospital, St Paul, MN, said that diabetic patients with neuropathy should be screened for certain biomechanical problems, such as limited ankle and great toe mobility. Identifying and monitoring diabetic patients with preexisting foot problems early in the course of the disease could improve the success of treatment for foot ulcers and lower the incidence of recurrence, infection, and amputation.
Bofelli added that structural and biomechanical problems often are overlooked when health care providers treat patients with diabetes.
He said patients with diabetic neuropathy and biomechanical problems should wear custom shoes or orthotic inserts as prescribed by a podiatric foot and ankle surgeon to reduce pressure. In some cases, however, surgery might be required to prevent or heal ulcers.
Source: Boffeli TJ, Bean JK, Natwick JR. Biomechanical abnormalities and ulcers of the great toe in patients with diabetes. J Foot Ankle Surg 2002; 41:359-64.