Reduction of Hospital Acquired Pressure Ulcers: The Clinical and financial Rewards of Changing Bedside Practice

Professional Practice

Reduction of Hospital Acquired Pressure Ulcers: The Clinical and Financial Rewards of Changing Bedside Practice PROBLEM: Patients from surrounding nursing homes are often transferred to our facility with multiple full-thickness pressure ulcers. The average Braden score on admission is 9 or less (high risk). Hospital acquired pressure ulcers increase the length of stay (LOS), decrease quality of life (QOL), increase morbidity and are an indicator of the quality of nursing care delivered.  Incidence rates at this facility are above the national average, 16 percent in 2004, 11 and 15 percent in 2006 and 2007. Hospital administration was not familiar with services that could be provided by a CWOCN and therefore such services were not available. GOALS: Reduction in the number of hospital acquired pressure ulcers while reducing associated costs and implementation of  evidence based practice guidelines.

PROCESS:  A critical care nurse educator interested in wound care was the advocate for replacing the hospital’s standard foam mattresses with pressure redistribution mattresses.   Initial education began with unit-based educational programs on identification, staging and current treatment of pressure ulcers which included a pretest and posttest.  One eight hour continuing education program was provided to further enhance understanding. Nursing care plans and protocols were revised.

OUTCOMES: The hospital reduced its rental of therapy beds by 50 percent and overlay rentals decreased to one per day which was down from 22 per day. The rate of hospital acquired pressure ulcers decreased to 3.2 percent compared to previous years of 16, 11 and 15 percent. The nurse educator achieved certification as a CWOCN and was added to the leadership team.CONCLUSION: Unit based education and on-going support provided by a CWOCN and adherence to evidenced based practice guidelines can have a significant impact on reducing hospital acquired pressure ulcers while reducing cost.