Purpose/Objective: Improve methods of patient skin care and skin protection to decrease number of hospital-acquired pressure ulcers (HAPUs), and formulate hospital-wide skin care protocols utilizing standardized set of skin care products.

 Methods: In 01/06 an interdisciplinary, cross-continuum, Skin Protection Task Force (SPTF) formed to develop, implement, and evaluate interventions to improve skin protection. The team reviewed surface and skin care products, developed a nursing education plan, and updated skin care protocols to incorporate evidence-based practices. A “skintastics” team of representatives from each adult unit served as resources for skin care excellence, and conducted quarterly pressure ulcer prevalence studies.  Incontinence barrier cloths were introduced to assure barrier application in high risk incontinent patients.

 Results:  New skin injury prevention protocol implementation for heels and bottoms during Q1 and Q2 2006 decreased prevalence of HAPU's in all units except the Step Down Unit. One example of percentage reduction: pre-implementation quarterly average of HAPU prevalence in Critical Care went from 15.6 to 2.6. Wound care consults decreased. Compliance to barrier application reached 83%. The estimated cost savings with this intervention reached $1,900,111.00.

 Conclusion/Implications Clinical Practice:

• Clinical pathways must adapt over time for positive outcomes.
  
• Skintastics team was successful in identifying care inconsistencies, implementing evidence-based practice strategies, and improving patient outcomes.
  
• New standardized protocols for IAD and HAPUs, coupled with new product technology, increased compliance and reduced skin injury.
  
• The preventive measure of the heel protector represented an approximate annual savings of $1,900,111.00.
  
• This project revealed the importance of compliance to barrier application and preventative use of heel protectors to eliminate HAPUs.
  
• As CMS imposes strict rules of nonpayment for HAPUs, prevention costs for pressure injury shelters itself from resultant reimbursement loss.