As pressure ulcer development in the hospital is now considered a “never event” by Medicare and pressure ulcer prevention and development is a focus on home health compare, it is increasingly clear that pressure ulcer prevention and management should be a priority for home health care delivery.
In January 2010 the home care industry first saw this change in the focus towards pressure ulcer prevention. OASIS-C is a modification to the Outcome and Assessment Information Set (OASIS) that Home Health Agencies must collect in order to participate in the Medicare program. Its goal is to improve patient quality and safety.
In addition to other changes within the OASIS-C, new process measures that will be reported on home health compare include whether or not:
- Pressure ulcer risk assessment was conducted
- Pressure ulcer prevention is on the plan of care
Outcomes measures reported on home health compare include the increase in number of pressure ulcers a patient develops while receiving home health care.
Not only does this mean each agency is being compared to each other on process and outcomes measures in a competitive market, but it also means that the quality of the individual home care agency is being monitored on whether or not they include best practices in their delivery of care. In the future, this may lead to reimbursement changes, similar to the “never events” in the hospital.
Health care providers know, however, that some pressure ulcers are unavoidable. Their best chance to improve their outcomes is to create a care plan to mitigate risk of pressure ulcer development. The answers lie within the OASIS- C tool.
M1300 Pressure Ulcer Assessment: Was this patient assessed for the Risk of Developing Pressure Ulcers?
The OASIS-C asks the home health agency to assess the patient’s risk of developing pressure ulcers without requiring the use of standardized tools. However, one very accurate way to assess this risk is by using a standardized tool, Braden Scale for Predicting Pressure Sore Risk in Home Care©.
The Braden Scale is an evidence-based risk assessment tool that looks at six factors related to pressure ulcer development – Sensory Perception, Moisture, Activity, Mobility, Nutrition and Friction and Shear. Each subscale has specific descriptors a patient may fit into leading to a sub score of 1 – 4 (1-3 in the friction and shear category). The total score can range from 6 to 23; the higher the score, the lower the risk for pressure ulcer development.
Proper staff training on use of the Braden Scale is important to ensure accurate assessment of pressure ulcer risk development. Appropriate intervals for assessment should also be determined.
M1302: Does this patient have a Risk of developing pressure ulcers?
A Patient with a Braden Score of 15 or less is at risk of pressure ulcer development. A plan to prevent a pressure ulcer should be implemented for these patients. OASIS-C asks for this as a best practice. M2250 asks for interventions to prevent pressure ulcers once a patient has been assessed to be at risk for pressure ulcer development to be included on the physician-ordered plan of care.
This is the time to put into place a comprehensive pressure ulcer prevention program by level of risk. Additionally, focus on the sub scale areas of greatest risk (i.e. focus on the management of moisture in an incontinent patient who scores 1).
Intervention by Level of Risk
The Braden Scale offers protocols by Level of Risk that can be assessed through the Prevention Plus website. Any of these protocols can be easily integrated into a care plan for home health patients.
The protocols should be followed by the entire team of home health professionals, caregivers and family members caring for this patient at home.
As best practices are utilized, the direct correlation will be the reduction of pressure ulcer development and improvement of quality in home care delivery.
For more wound care resources, visit CHAMP’s tools page.
