Policy development and implementation across health care settings is fundamental in maintaining and improving public health. Considering this fact, the Nursing Facilities Policy at McGregor PACE (Program of All-Inclusive Care for the Elderly) is in dire need of a change. The Nursing Facilities Policy was written in 1998, when McGregor PACE first opened its doors to the frail, elderly of Cuyahoga County. The last revision date was in May of 2007, and it was last reviewed in July of 2011. The policy describes standard procedures for any PACE participant being admitted to or discharged from a nursing facility. The purpose of the policy is to promote coordination of care. It ...view middle of the document...
d.). McGregor PACE staff is responsible for oversight of care regardless of the fact that nursing home staff provides nursing and supplemental care during the admission. The McGregor PACE team maintains complete responsibility of the entire plan of care and health management of its participants 24 hours a day, seven days a week ("Quick Facts PACE," 2008, p. 2-3). One of the key areas this policy does not address is skin assessment. There are currently no requirements of the McGregor PACE team, within the Nursing Facilities Policy, to assess the participant’s skin before or after transfers to and from any acute care/or skilled nursing facility. This task would primarily fall upon the McGregor PACE nursing staff and primary care providers if it were to be incorporated into the Nursing Facilities Policy. I will further discuss the necessity for this policy change, and its impact on elderly participants enrolled in the McGregor PACE program.
This policy was selected because over the past six months there have been several Level Two events at McGregor PACE involving participants being discharged from an acute care stay with newly developed, Stage III, decubitus ulcers. A Stage III ulcer is described by the Center for Medicare and Medicaid Services (CMS) as a pressure ulcer with full thickness skin loss involving damage or necrosis of subcutaneous tissue ("PACE Level Two Reporting," 2010, p. 6). The ulcers were not identified by McGregor PACE nursing staff prior to admission to the nursing facility, nor were they identified by facility staff or PACE nursing staff, during admission or upon discharge home. The decubitus ulcers were reported by family members of the participant, post-discharge. Therefore, the McGregor PACE team was unable to detect exactly when the skin breakdown occurred. The Nursing Facilities Policy has no specifications as to when, or how frequently nursing staff must perform skin assessments on its participants. There was no skin assessments performed on the above stated participants before, during or after their hospital admissions. According to The Center for Medicare and Medicaid Services, Level Two reporting requirements apply specifically to unusual incidents that result in serious adverse participant outcomes, or negative national or regional notoriety related to the PACE program("PACE Level Two Reporting," 2010, p. 4).
I feel that these cases may have been prevented had there been, within the Nursing Facilities Policy, a requirement of McGregor PACE nursing staff to assess the skin of all participants within 24 hours of being transferred to, or being discharged from an acute care/or skilled nursing facility, as well as daily while in a facility. Pressure ulcers are among the most common conditions encountered in patients’ acutely hospitalized or requiring long-term institutional care (Berlowitz, 2013, para. 5). In older adults pressure ulcers have numerous detrimental...