Resource Management

Peer Response: Length: A minimum of 150 words per post, not including references Citations: At least one high-level scholarly reference in APA per post from within the last 5 years Peer Post: Pressure ulcers are deemed preventable using such frequent repositioning, dietary interventions and good skin care. CMS considers Stage III and Stage IV pressure ulcers a never event, with the possible exception of hospice patients. Advanced stage pressure ulcers can cause disfigurement and possibly death through infection. The Joint Commission, often used by CMS as a benchmark, categorizes pressure ulcers as sentinel events (JointCommissionOnline, 2016).  CMS’s new directives, known as Hospital Acquired Condition (HAC) Reduction Program, (CMS.gov, 2020) reduces or eliminates payment for hospital-acquired pressure ulcers (CMS.gov, 2020).  Pressure ulcer prevention became one of the quality initiatives because pressure ulcers, especially Stage III ulcers, are painful for the patient. Stage IV ulcers usually lack enervation, so are less painful, but both Stage III and Stage IV ulcers are vulnerable to infection. Both Stage III and Stage IV wounds are expensive, often requiring expensive wound care supplies, nursing care, specialty equipment such as special beds and sometimes even surgeries. Making pressure wounds expensive for the hospitals means hospitals may work harder to prevent pressure ulcer formation. APNs should use care to prevent pressure ulcers, and be very careful to treat Stage I and II pressure ulcers aggressively so they don’t advance any further.  Catheter-associated urinary tract infections (CAUTI) are also considered sentinel events. CAUTIs can become dangerous in certain circumstances, and according to CMS (2020) became very frequent. To reduce the incidents of CAUTIs, CMS financially penalizes hospitals for CAUTIs.  Again, this becomes expensive for the hospitals as they are required to treat the patients and the HAC with no or lessened reimbursement. Quality Assurance (QA) RNs usually insist that indwelling catheters have a reason, other than convenience, to be placed, such as a need for strict intake and output measurement. Once the need is done, the QA RN will insist upon discontinuance to diminish the chance of a CAUTI. APNs may order indwelling catheters to be discontinued as soon as possible.  CMS.gov. (2020). Hospital-acquired condition reduction program. CMS.gov. July 21, 2020. Retrieved on August 13, 2020 from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HAC/Hospital-Acquired-Conditions JointCommissionOnline. (2016). In this issue. JointCommissionOnline.com. July 27, 2016. Retrieved on August 13, 2020 from https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission-online/jc_online_july_271pdf.pdf?db=web&hash=CBF1BC4CBBD8A9F25E4612F9F1499CB3#:~:text=The%20presence%20of%20pressure%20ulcers,could%20be%20a%20sentinel%20event.