More than 40% of ICS members are at risk of skin breakdown, that is, of developing a pressure ulcer or wound. Yet, in 2012, of ICS’s then more than 3,500 members receiving long-term care services in the community, fewer than 1% developed a new pressure ulcer. While rates of comparison are inexact, studies show an incidence of wound development among non-acute patients in hospital and nursing homes receiving long-term care at 8.5%–much higher than ICS’s wound development rate.
Wounds occur most frequently to people who use wheelchairs or who are in bed for long periods of time, people whose diagnoses range from spinal cord injury to CVA to multiple sclerosis, muscular dystrophy, cerebral palsy and spina bifida. Brought about by unrelieved pressure that damages the skin and underlying tissue, pressure ulcers pose a serious health threat, causing pain, systemic infection, amputations, and even death.
Recognizing the risk posed by pressure ulcers for so many ICS members, ICS in 2003 established a Pressure Ulcer Prevention and Comprehensive Wound Management Program. Headed by Dee Visco, a Certified Wound Care Nurse and expert in the field, the Program makes ICS unique among long-term care programs. That’s because ICS’s nurses assess every member at intake and every 180 days thereafter for their risk of developing a pressure ulcer, using the Braden Scale. They then administer the Skin Integrity Interventions form developed by ICS, which provides recommendations for specific actions that correspond to the Braden score.
ICS’s social work care managers take it from there. In regular contact with ICS members, involved relatives, and home care aides, they carry out the interventions, a responsibility that is critical to ICS’s success in wound prevention. Nellie Merced, a social work care manager with ICS for nine years, appreciates the opportunity to teach ICS members at risk of skin breakdown how serious a wound can be and what they can do to protect themselves. She advises members about using skin inspection mirrors or skin barrier ointment; makes sure that the cushions on their wheelchairs are in tip top shape; makes referrals for pressure-relieving mattresses or wheelchair seating evaluations; recommends nutritional supplements; and refers for physical and occupational therapy.
“I love our Wound Care Program because I see results,” Nellie says. “When I visit members, they know that I know what I’m talking about, that I can help them prevent wounds, help them to stay healthy and feel comfortable. That gives them confidence, and I feel like I’ve made a difference.”
To both prevent wounds, and to manage wounds so that they don’t worsen and require repeated hospitalizations, ICS social work care managers work closely with Dee and her Wound Care Team. The Team has two other staff members—Patti Mazone, also a Certified Wound Care Nurse, with ICS’s Wound Care Program since its inception, and the newest Team member, Sylvia Springer-Fahie, a Wound Care Nurse awaiting final certification, with ICS for a year. “Patti and Sylvia are the heart of the Wound Care Program,” says Dee. “They visit the members and provide ongoing follow-up to help the members optimize their ability to heal their wounds. Their hard work and dedication have been crucial to the success of the Program.”
The Wound Care Team coordinates the care of ICS members who have wounds with physicians and allied health professionals at leading Wound Care Centers in New York City, with which ICS has established ongoing partnerships. That is where ICS members receive evaluation and treatment, often accompanied by a wound care nurse or their ICS care manager. During 2012, of the ICS members whose wound care was being managed by our wound care staff, only 6.6% had a wound-related hospitalization.
Of the progress of ICS’s Wound Care Program, Dee Visco says: “We have seen an increase in the number of members getting support services aimed at preventing skin breakdown. That will mean even lower rates of pressure ulcer development in the future, even fewer complications and hospitalizations, and a much better quality of life for our members. That is heartening to me; it means we’re getting this work right.”