PRINCETON, N.J.--After nearly two years of applying best practices and preventive techniques, 150 hospitals, nursing homes and home care agencies in New Jersey tracked a 70 percent reduction in the incidence of new pressure ulcers in their patients.

Ranging from redness and irritation to extensive destruction of tissue, muscle and bone, pressure ulcers, commonly known as bed sores, affect more than 1 million patients annually. Costs associated with their treatment exceed $1.3 billion, according to the New Jersey Hospital Association.

More important, the association said, "the human toll of pain, depression, altered self-image, infection and increased mortality is immeasurable."

Of the organizations taking part in the NJHA's Pressure Ulcer Collaborative, 48 reported achieving results of no new pressure ulcers for a period of three months or more. In addition, data showed that the prevalence of existing pressure ulcers as patients moved from one care setting to another was reduced by 30 percent.

Data was tracked from September 2005 through May 2007.

Improvement techniques used by staff across care settings included:

--a complete skin evaluation within eight hours of admission;
--an evaluation of the risk of skin breakdown;
--implementation of preventive strategies, such as proper positioning and use of assistive devices; and
--ongoing observation of the condition of patients' skin, particularly for those identified as being at high risk for developing a pressure ulcer.

As part of the bundle of interventions for home patients, "once an individual was identified as being at risk for development of pressure ulcers, we wanted [the care provider] to strive for implementation of some kind of preventive intervention within 24 hours of that risk being identified," said Theresa Edelstein, NJHA's vice president of continuing care services.

The organizations taking part in the project were given a review of various positioning and support surface devices to help "understand the principles behind each of those different types of devices and how they are utilized with different patient populations, such as critical care and hospice," Edelstein said. No specific type or brand was recommended, she added, but educating the organizations about the preventive devices led many "to take a look at their protocols and how they are making use of these devices with a better understanding of what they are meant to do."

As a result, Edelstein said, some of the home care agencies involved "documented a significant reduction in rehospitalization rates related to wound infection and wound care in general. The agencies have seen that they made a difference, and that's a very exciting and positive result for them and for their patients."

A second phase of the project is being planned, Edelstein said, because there are many different facets of dealing with pressure ulcers, and not all of them are avoidable. The sores could be nutrition-related, medication-related or dressing-related, "and all of those things intertwine," she said.

"We want to know what is the best way to get the best results for those patients who develop a pressure ulcer in spite of our best efforts."