A dedicated Skin Team, whose driving mission was improved cost effective patient care, facilitated a decrease in the prevalence of pressure ulcers throughout a comprehensive integrated Health Care System*. Improved outcomes were demonstrated over four consecutive quarters and were achieved through the standardization of both product formulary and patient care order sets. The cohesive framework for success consisted of an intensive system-wide education process and subsequent quality improvement outcome feedback from quarterly pressure ulcer prevalence survey results.

An educational program raised the awareness of prevention and treatment of pressure ulcers across the health system. Also, revision of existing physician order sets in conjunction with a standardized product formulary contributed to the seamless delivery of care system-wide. The Skin Team presented vendor supported inservices to all units. Multiple forms of education included: formal classroom sessions, one on one “huddle” inservices, and staff meeting presentations to insure that all caregivers received prevention information. Display boards, depicting standardized skin products, were distributed to all units.

As a reflection of the Health System's commitment to reduction of pressure ulcers, a program of weekly skin rounds was implemented on previously high prevalence units. Skin team members rounded on every patient in the unit weekly. Charts were reviewed with interventions updated as needed. To enhance these efforts, the electronic medical record was revised to more accurately reflect the needs related to skin and wound assessments.

These activities all contributed to a reduced overall prevalence of nosocomial pressure ulcers in the acute care facilities of the Health System from 17.53% to 4.6% over the four quarters surveyed. Overall cost savings has not been calculated as yet, but will serve as the basis for future health economics outcomes research.

*Palomar Pomerado Health-Consisting of 2 acute care hospitals, 2 skilled long term care facilities and a home health agency.