In his article, “100 Years of Bedsores: How Much Have We Learned?” Jeffrey Levine provides a measure of progress made during the last century, but also observes that, ‘the distance travelled is shorter than we‘d like to admit’.
In this age of technological advancement, why do “bed sores” – which are more accurately termed Force Related Tissue Damage – still occur when patients are confined to bed? Not only that, with NHS funding cuts continually sought, it amazes me that more is not done to prevent them considering prevention costs are dwarfed by the costs of failure.
Yes, healthcare institutions follow legislation, guidelines and recommendations from organisations such as HSE, IOSH, NPUAP, EPUAP and NBE. But all this demonstrates is they are meeting minimum legal obligations. Yet for advancement in care, following these is not enough. The NPUAP/ EPUAP guidelines for example do not recognise the real causes of force-related tissue damage. They are based on out-of-date science which means that many of the widely accepted products and practices being used for the care of inbed patients do not protect the patient.
Even the term, “bed sore” is an illustration of the lack of willingness to acknowledge latest research and adapt, as challenged in the British Journal of Nursing’s Tissue Viability Supplement**
So why is it that new technology and scientific findings are not being implemented?
Some might blame a knowledge gap and an over-reliance on group purchasing schemes to be providing the ‘best’ products despite their main focus being on unit price rather than safe patient care. In her article, Injury and Harm – How Do You Think Those Sound to a Jury? Caroline Fife MD discusses that in the USA, the CMS excludes force-related tissue damage from its list of 4 serious preventable events yet, “The legislative language… identified pressure ulcers as high volume, high cost, important hospital-acquired complications for which prevention guidelines existed that can be implemented to improve quality of care”.
In other industries, ignorance is not a defence – if senior management chose to ignore new research and scientifically-proven facts that can prevent injury and death, it would be viewed as a gross breach of their duty of care and where proven to be as a result of serious management failures could be construed as corporate manslaughter.
Another view is that the terminology used is compounding the fact. Harm Smit, Independent researcher at Biomedserv BV Amersfoort, shared in Wounds UK, “I strongly believe that moving away from any descriptive terms to a mere generic term will stop us spending time discussing non-relevant issues such as ‘ulcer’ or ‘injury’, allowing us to open up the dramatically needed scientific progress in diagnosing and treating decubitus (force-related tissue damage). The everyday clinical reality can only benefit.”
The third and most cynical barrier to the prevention of care advancement for patients confined to bed is the financial implications for the firms who make, promote and train in the currently accepted products and procedures. When livelihoods are at stake – even if they are based on science and technology that has been surpassed – there is always the added “selfish interest” incentive to discredit or dismiss advancements in technology and care.
Surely a “patients first” approach should always be the priority and with it, the continual improvement of care through new technology and best practice for patients confined to bed?
References:
http://www.npuap.org/wp-content/uploads/2012/01/NPUAP-Position-Statement-on-Staging-Jan-2017.pdf
https://www.linkedin.com/pulse/open-letter-presidents-npuap-epuap-phil-strong/
- “Time to challenge the continued use of the term pressure ulcer” by Amit Gefen, Professor in Biomedical Engineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University. Published in the British Journal of Nursing 2017 vol 26 no. 15 Tissue Viability Supplement.
http://www.hse.gov.uk/corpmanslaughter/
https://carolinefifemd.com/2018/02/23/injury-and-harm-how-do-you-think-those-sound-to-a-jury/
