Multidisciplinary Evidence-Based Quality Improvement Initiative in an Acute-Care Hospital

 Purpose/Objectives: A quality improvement (QI) initiative was undertaken on 4 units in an acute-care hospital with the purpose of ensuring evidence-based pressure ulcer prevention best practices were implemented at the patient’s bedside. The objectives of this QI initiative were 2-fold: 1) reduce hospital-acquired pressure ulcers (HAPU) incidence; and 2) reduce excess economic costs related to bed-rental fees. This project required a focused team effort on clinical practice innovation. Methods: In order to achieve the purpose and objectives of the QI initiative, the Skin Care Committee (a combination of 18 RNs and 4 WOCNs) adopted an evidence-based approach to clinical practice innovation by conducting a literature review, updating the hospital policy on PU prevention and wound care after reviewing new research and evidence-based guidelines, and collaborating on caregiver education. The hospital also implemented the pressure ulcer (PU) prevention guidance provided by the Indiana PU Quality Improvement Initiative (IPUQII) under the direction of the Indiana State Department of Health. The QI interventions included: 1) PU prevention efforts tailored to patient Braden scale, activity, mobility, sensory perception, and moisture; 2) ongoing caregiver education with pre/post tests for instruction on best practices for PU prevention, and competency evaluations for appropriate wound, ostomy, and continence care; and 3) support surfaces were updated to ensure patients received optimum pressure redistribution and lessen the need for bed rentals. In order to measure the success of our QI initiative, we compared cumulative HAPU incidence rates (prevalence and incidence surveys) and economic outcomes (bed-rental invoices) from 1-year historical baseline to 1 year after launching the QI initiative. Results: The before-after comparison resulted in a 54% reduction in HAPU incidence and a 77% reduction in bed rental costs. Conclusion: The interdisciplinary team approach to PU prevention was deemed a success and resulted in improved patient and economic outcomes.