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In 2006 pressure ulcer (PU) rates at our Regional 375-bed acute care facility were well above International and Canadian benchmarks with a facility-acquired rate of 21.1%. Subsequently, a PU Prevention and Wound Treatment Program was implemented. By 2009, facility-acquired PU’s decreased by 50% to 10.5%. However, heel pressure ulcer (hPU) occurrence had worsened. 5.8% of patients developed a hPU, ranking heels as the number one location for facility- acquired PU’s. hPU’s are costly and can lead to osteomyelitis and limb amputation. An initiative was needed to reduce these rates.
Methods
In 2009 a Corporate hPU Prevention Initiative was implemented following acceptance of a Business Case emphasizing the benefit in patient quality of life and cost avoidance. Components of this protocol included: use of a cushioned heel off-loading device for patients meeting inclusion criteria, extensive staff education and timely accessibility to the device. Outcome monitoring included inpatient data collection during day and night shifts at 6, 10, and 17-months post-implementation.
Results
Six-month data revealed 43% of patients met criteria to use the device, and of these patients 37% were compliant, resulting in a 40% reduction in hPU’s. 10-month data revealed 19% of the 44% of patients who met the criteria were compliant, resulting in a 28% decrease in hPU’s. Interestingly with 17-month data, only 17% of the 49% of patients who met criteria were using the device yet only 2.6% of the patients had a hPU.This reduction equates to an approximate cost avoidance of $1.5 million dollars annually and improved quality of life for patients.
Conclusions
Facility acquired hPU rates have decreased 55%. The positive outcomes seen thus far are a result of extensive staff education including: risk identification, frequent skin assessment, and device use as necessary. The challenge is to increase protocol compliance to further enhance outcomes.