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Is The Lack Of Continuity In Patient Care Responsible For The Endless Bedsore Problem?

hospital patientSometimes I get sick of hearing about the ‘good ol’ days’–  when homes were affordable, people were friendlier, milk tasted like milk (as opposed to some whitish water)— and how life may have been a little bit better?

Certainly, I’m not one to bicker about they way things were and how tough everything is now, but I certainly have developed a respect for both traditions and learning how to do things fundamentally correctly– without the addition of all the new gizmo’s that always promise to improve on the way things were done yesterday.

I began having a hankering for nostalgia after I read an article a colleague emailed me from England, “Why in the 21st century, are NHS patients dying in agony from bedsores?” The article readily references a new book on the British healthcare system, by Michael Mandelstam, “How We Treat The Sick: Neglect And Abuse In Our Health Services.”

Reading though the article and book references within the article, it appears that both authors blame modern developments in our healthcare system for the systematic increases in bedsores and other medical complications that are acquired by patients during their admissions to hospitals and nursing homes.

In particular, the writers cite the lack of continuity of care from all types of hospital staff, nurses, orderlies, and doctors as one of the main reasons we are seeing the modern day bedsore epidemic at many medical facilities.

In the good ol days, nurses and doctors were assigned particular patients whom they typically cared for during their entire admission or stay.  While caring for the same patients day-in and day-out must have help ease patient nerves, it also encouraged the staff to care for patients with a sense of pride! After all, would anyone want their professionalism questioned when a patient developed a bedsore– due to their inattentive care?

As Dr. Matin Scurr sums up the current situation:

I’ve written before about the lack of continuity of care as a result of destroying the ‘firm’– a paitent used to be assisnged to one firm (or team) of medics.  The firm comprised one or two house offices (recently graduated doctors), the senior house officers, registrars and, at the top of the hierarchy, the consultant.

This firm ensured continuty of patient care.  But the firm is no more.  No patient care has become like a high-risk version of pass-the-parcel — patients are simply handled from doctor to doctor with notes in a folder and no one following them through.

I couldn’t agree more with Dr. Scurr’s assessment!  Particularly as evidenced by the development of bedsores during hospitalization or nursing home stay , it is important to remember their development is really a sign of systematic neglect— as opposed to the inadequate care of a few caregivers.

While we may indeed see the development of other types hospital-acquired complications (medication errors, dropped patients, ect.) derive from a situation involving an individuals poor judgment, bedsores are really emblematic of systematic neglect.  Even in the most fragile patients, bedsores– particularly advanced wounds (stage 4 bedsores) develop over periods of days and weeks.

When evaluated as a progressive condition, it usually becomes apparent that not only was the staff not doing their job in terms of bedsore prevention— but perhaps equally importantly– staff may not have been implementing the necessary medical treatments as the wound progressed.

I can only imagine that forcing a personal accountability issue medical staff would lead to situations where patient care would inherently improve– both out of the staff’s personal pride and perhaps– fear over personal responsibility over their visibly inadequate care.  Indeed, perhaps its time we take a page from the past and acknowledge seemingly improved efficiencies doesn’t translate to better patient care.

Related:

Families Must Educate Themselves When It Comes To Bed Sores Acquired In A Nursing Home Or Hospital

How many hospital patients suffer from bed sores?

Reducing Decubitus Ulcers In Hospitals. How One Facility Managed To Reduce Hospital-Acquired Wounds By 63%

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  • I agree with your indignation and wonder why the health care profession as a whole isn’t as concerned. How do I know they aren’t concerned? Because I have reason to visit hospitals, nursing homes, hospice and home health care companies and when I ask them about their pressure sore issues they all assure me, “we don’t have that problem any more!” Very strange when the statistics suggest that in the US 100,000 people a year die from them and the people who compile the statistics alway include a disclaimer that the problem “may be larger because not all facilities report.” No kidding. If they are correct and 100,000 is the number then the problem is equivalent to crashing an airliner into the ground with 275 people…every day! Forever!
    Why do I care, why do I ask? Two years ago, because of my success in developing unique products for the military and aerospace community that prevent pressure sores in this group (young, strong, healthy with chronic sores from helmets and seats) I was approached by the presidents of the Oregon, California and Washington hospital associations and asked if I could develop a “fix” for the problem.
    They thought the problem was from pressure…it’s not that simple.
    The large issues that need to be resolved are pressure, heat, moisture, friction and shear. Pressure is unavoidable living in a one G environment and any of the other issues can also trigger the tissue breakdown as well.
    Other issues not generally recognized as significant are, but not limited to, cost, stability, ease of deployment, storage, cleaning, bio burden accumulation, longevity, durability, thickness, maintenance, reliability, patient acceptance, comfort and staff acceptance. There are others but you get the idea, single, symptom specific answers aren’t going to work.
    Looking at the problem as a system it becomes immediately apparent that no one has thought this through as a system or even looked at history to see what has been tried before. We wait for the pressure sore to manifest itself then apply chemistry to fix a physics issue. Pressure sores are not a disease but rather an injury. Why are we expecting chemistry to resolve a physics problem? We don’t use salves and goop on a broken bone, we immobilize it in a cast. Broken leg, physics issue, fix, physics issue, no chemistry.
    The oldest recorded history I can find on how to treat pressure sores dates from about 2000BC. The ancient Egyptians used elemental silver and compounds of honey with no result as seen by the pressure sores exhibited on mummies. Today we are using essentially the same compounds expecting a different result.
    In one of my facilities we use a classified, patented process to make military products I can’t tell you about but I will tell you they don’t explode. I’ve taken this process and modified it for the hospital application and developed a simple, (no moving parts) easily deployed, (one nurse while the patient is still in the bed) easily cleaned, (with a bleach wipe) self cooling, (an air cycle process) low pressure return, (simulates lunar gravity by creating a level Indentation Force Deflection curve (IFD) less than vascular closure pressure) water proof, blood proof, virus proof, bacteria proof, (as lab tested) minimal weight (12 pounds) non powered, (no hoses, pumps or wires) durable, (easily passed a 20 year mattress test) low profile, (1″) minimal storage, (10″x10″x18″ box) will not slide on the bed, (microscopic suction cups, .001″ diameter grip any surface) low cost, (as low as $5 a day lease, we guarantee satisfaction and provide replacement if needed) comfortable, (the patients say so,we guarantee this as well). All this from non Newtonian physics, no chemistry and no side affects.
    How well does this work in the real world?
    It’s been fully deployed in a 40 bed hospital for over two years with no pressure sores save one small stage one caused by an undetected diarrheal event which resolved itself after discovery and cleaning. Other deployments include numerous hospice and nursing home facilities.
    To date the total successful patent days exceed 39,000 with the one negative event. Additionally, after placing patients with existing ulcers on the overlay surface stage one and two ulcers are resolved in 10-14 days, stage three in 20-22 days and stage four in 30-36 days. The device does NOT heal the ulcer, it provides an environment that allows and encourages the body to do the healing.
    This is an FDA Class One device, as such we can not make claims for efficacy but we will guarantee complete satisfaction or your money back. NO RISK!
    Why hasn’t the world taken this up instantly? Because its too good to be true and no one expects any device to bring more the 10-15% improvement to any medical issue. The chief of nursing at Oregon Health Sciences University (currently doing a very slow study) says an improvement of 2% is worth deploying but an improvement of 20% “doesn’t happen.”
    If anyone is interested I will be happy to provide the supporting documentation.
    Respectfully,
    Mike Dennis

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