November 20, 2008
In 1992, the first guidelines about how to prevent pressure ulcers, or bedsores, were published.
Few changes have been made in 16 years although much more research on the topic is needed, said Dr. Courtney H. Lyder, dean of the UCLA School of Nursing and associate director of Ronald Reagan UCLA Medical Center, who was the keynote speaker Tuesday for the 2008 Siegfried Lowin Visiting Scholar Lecture Series in the East Carolina University College of Nursing.
Lyder is helping lead the charge.
A respected researcher in patient safety, geriatric nursing and a leading advocate for health care diversity, a key study area for Lyder has been identifying early indicators for tissue damage that could lead to pressure ulcers particularly in minority populations.
Lyder said 82 percent of all ulcers occur on three spots: sacrum, heels or hips. The cost associated with pressure ulcers is conservatively estimated at $11 billion annually, with increasing litigation and hospital-acquired non-payment. The average settlement from litigation is $250,000.
"Why is it a huge concern? Because most ulcers are preventable," Lyder said.
Lyder calls the standard method of prevention - turning a bedridden patient every two hours - one of the 'sacred cows' in nursing.
"There is no basis for every two hours," Lyder said. "We need a lot more work to break the sacred cow we've been stuck on."
He said investigators really don't know how much time it takes to induce an ulcer.
Pressure ulcers are categorized from Stage I to Stage IV as well as a more recent diagnosis, deep tissue injury.
A risk assessment tool was developed in the late '80s by Barbara Braden and published in 1992. Lyder was an undergraduate research assistant at Rush University who worked on validating the Braden Scale, which is still the most widely used in the United States and abroad to determine a person's chance of developing pressure ulcers. It includes hip fractures, decreased sensory, history of previous pressure ulcers, CVA, diabetes, limited mobility, PVD, unintended weight loss, COPD, incontinence, terminal disease and physical restraints.
Lyder has been involved in ongoing research that shows COPD, CVD, diabetes, obesity, corticosteroids or smoking may be better predictors of who will get pressure ulcers.
Research also shows that people with pressure ulcers are at two fold risk of dying and people of color with bedsores are three times more likely to die, and the chances increase if the person is in a long-term care setting, Lyder said.
"We're not saying the pressure ulcer caused the death, but it may be the last insult to the body before the death," Lyder said.
Lyder, who was named dean of the UCLA nursing school four months ago, has garnered $12 million for research as a principal investigator and has authored more than 170 publications including two books.
Previously Lyder was a faculty member at the University of Virginia where he chaired the acute and specialty care department in the School of Nursing and served as director for diversity initiatives. Between 1994 and 2003, he served on faculty at the Yale University School of Nursing, where he directed a number of programs specializing in adult, family, women's and elder care as well as chronic wound care.
Research and new technology will help in the prevention of pressure ulcers, Lyder said. For instance, manufacturers are designing 'thinking beds' to place sensors inside the cells of beds that would alert caregivers to prolonged pressure.
The lecture series began in 2007 through the generosity of ECU faculty members Dr. Mary Ann Rose and Dr. Walter Pories. It is named in memory of Dr. Pories' relative, Siegfried Lowin, who died in 1989. Lowin greatly respected the nurses who cared for him throughout his extended illness and the lecture series was given to the ECU College of Nursing in his honor.