A Lean Strategy Can Prevent Bedsores

The number of hospital patients with bedsores is increasing dramatically – and if ever a problem cried out for a lean solution, this is it.

The problem was described recently in The New York Times. The article, by Roni Caryn Rabin, noted that more than half a million patients admitted to U.S. hospitals in 2006 suffered bedsores, an increase of 78.9 percent since 1993. Total hospital admissions increased only 15 percent during the same period.

“Bedsores are preventable, but it’s not easy,” said William Spector, a researcher at the federal Agency for Healthcare Research and Quality. “It’s not like you just get a prescription and one physician can take care of it. It’s a major team effort that requires a multidisciplinary team of dietary aides, nurses aides, physical therapists and physicians all playing a role.”

Although the report did not explain why bedsores had become so much more frequent, an official with the American Hospital Association speculated that the increase may be due to rising numbers of very frail, elderly patients arriving in hospitals.

“We know we’re seeing older patients, patients who are sicker than they were a decade or more ago, and more patients whose immune systems are compromised by advanced age and some drug regimens,” said Nancy Foster, vice president for quality and patient safety policy with the A.H.A.

It’s also possible that greater attention to bedsores by hospital staff has led to improved record-keeping and a more accurate accounting of their numbers, she said.

Elderly patients and those who are bedridden or immobile are most vulnerable to bedsores, especially if the patients are not well-nourished or their immune systems are compromised. The sores, called decubitus ulcers, develop when there is constant pressure on the skin, and they can lead to serious, life-threatening infections.

Turning bedridden patients every two hours helps to reduce pressure on the skin. One hospital has started playing the song “Turn, Turn, Turn” to remind nurses that they should be turning their patients, Ms. Foster said.

So this is a preventable problem, and preventing it also prevents more serious complications. Further, the solution involves making sure certain actions are taken at certain times – in other words, the problem can be addressed by improving the process. And nothing improves a process better than a lean approach.

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