Incontinence related skin injury and heel ulcers can cost millions! How Harris County Hospital District virtually reduced these costly adverse outcomes

Topic:

The new "present on admission" or "never event" regulations created by the US Centers for Medicare and Medicaid Services (CMS) challenge all hospitals to link quality and financial performance.   Among these conditions were hospital-acquired pressure ulcers where changes to reimbursement became effective on October 1, 2008.

Purpose:

A need for skin and heel protection guidelines was identified in a large hospital district. Current cleansing practice for incontinent patients included bar soap and minimal protection.  Protection of heel ulcers for critical patients included use of pillows.  Skin damage from incontinence and heel damage from pressure were prevalent.

Objectives:

Attendee will be able to identify interventions used to prevent incontinence induced skin injury.

Attendee will be able to identify interventions used to prevent heel ulcers.

Outcomes:

Bathing and cleanup processes were created and implemented district wide.

• Ambulatory patients used shower cleanser
• Bed bound patients received daily basinless bath using no rinse bathing cloth
• Barrier cloths were used for protection of the skin
• Briefs were used on patients out of bed
• Polymer pads placed under incontinent patients  

To prevent and reduce complications of heel ulcers in the critically ill patient, the following guideline for use of an offloading boot was created and initiated:

• Sedation for a minimum of 5 days along with presence or absence of intubation
• Braden score of 18 or less or mobility sub-group of 2 or less
• Paraplegia or Quadripegia
• Decreased sensation of the lower extremities

With implementation of basinless cloths and offloading boots, a significant reduction in skin and heel related complications were noted.  Decreasing complications in these areas supported a reduction in cost associated with care of these patients.