1. Edelstein, Theresa LNHA

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Panel Presents Wound Care Practice Recommendations to MedPAC

At its recent meeting, the Medicare Payment Advisory Commission (MedPAC) heard the recommendations brought forth by its panel on home health process measures. MedPAC convened the panel of experts in home care, quality measurement, and government representatives to identify process measures that would apply to most home health patients. The panel's 2 areas of focus were fall prevention and wound care practices. Best practices, data needed to measure these practices, and evidence linking best practices to improved outcomes were key topics discussed by the panel.


In the area of wound care, the panel recommended the following practices:


* head-to-toe standardized assessments


* using wound photographs to monitor progress


* gearing treatment toward pressure relief, infection control, and wound bed preparation.


* communication and coordination with physicians to initiate these practices.



Within the New Jersey Hospital Association (NJHA), the MedPAC panel's recommendations on wound care practices were of particular interest because of its ongoing efforts with The NJHA Collaborative to Reduce the Incidence and Severity of Pressure Ulcers throughout the Continuum of Care. About a dozen New Jersey Medicare-certified home health agencies, including some of the largest providers of home care services, are part of this important effort. Their goal is to work in partnership with hospitals and skilled nursing facilities to effect change in the area of skin care.


In fact, the primary goal of the NJHA Collaborative is to reduce the incidence of pressure ulcers by 25% in 1 year, with an emphasis on patients who are treated in multiple settings. Another objective is to improve the collaboration, communication, and coordination among the health care providers who assess each patient's level of risk for skin breakdown and then initiate preventive measures.


The process of measures includes using the Braden scale to establish whether the patient is at risk for developing a pressure ulcer on admission and at prescribed intervals, regardless of whether the patient is served by a home health agency, hospital, or skilled nursing facility. It also includes the use of appropriate pressure-relieving devices and turning/positioning schedules for patients identified as being at risk. To help clinicians remember key aspects of preventing and reducing the incidence of pressure ulcers, Elizabeth A. Ayello, PhD, RN, APRN,BC, CWOCN, FAPWCA, FAAN, has created memory jogger mnemonics (Table 1).

Table 1 - Click to enlarge in new windowTable 1. MEMORY JOGGER MNEMONICS

To date, the home health agency participants have been among the most successful in implementing the bundle of interventions, adapting the interventions to their setting, and in reporting results.


MedPAC is scheduled to provide the US Congress with recommendations on home health process measures in its June 2006 report. The NJHA expects to receive the preliminary results from the first year of the pressure ulcer collaborative by September 2006. The NJHA also hopes to contribute its findings to both MedPAC's and the Centers for Medicare & Medicaid Service's deliberations on process measures for wound care in the home health setting.


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