Background: The prevalence of pressure ulcers, pressure ulcer prevention and management strategies as well as quality improvement (QI) initiatives in the Long-Term Acute Care Hospital (LTACH) setting is largely under-reported in the literature. Implementation of QI initiatives in other venues has resulted in pressure ulcer prevalence rate reductions. There is no literature to support if QI activities would have a similar impact in the LTACH arena. Our goal was to establish prevalence rates and evaluate the impact of QI initiatives in this setting.

Methods: An interdisciplinary skin care team was created with the intent to reduce the facility acquired rate and overall prevalence to that of the reported national LTACH pressure ulcer rates of 7% and 27.3%¹ respectively. Institutional prevalence studies were performed. Based on the collected data, a comprehensive quality improvement initiative was established. Included in this effort was the implementation of standards of care for wound prevention and management, staff education and the acquisition of appropriate research-based wound care products.

Results: Prior to initiating the quality improvement process, facility acquired pressure ulcer rates varied by unit from 16-25% with an overall combined community and facility acquired rate of 33-58.3%. Since the beginning of the quality improvement initiative, which also included feedback to clinicians regarding the wound consult, the facility acquired pressure ulcer rates have markedly decreased and remain in a range of 3.1-7.4% Conclusion: Using a multi-dimensional, interdisciplinary QI approach can reduce pressure ulcer prevalence rates in the LTACH setting. Further studies in the LTACH setting are warranted.

¹ Vangilder C, Eckstein A, Decker, S, & MacFarlane G: 2005 International Pressure Ulcer Prevalence Survey Results for US Long-Term Care Facilities. Program and abstracts of the 19th Annual Symposium on Advanced Wound Care and 16th Annual Medical Research Forum on Wound Repair, San Antonio TX, April 30-May 3, 2006.