Digging Deeper: Attempts to Achieve and Irreducible Minimum for Hospital Acquired Pressure Ulcer Rates

Background

Since October 1, 2008  when the Center for Medicare and Medicaid Services (CMS) implemented withholding of payment for hospital acquired Stage III and IV pressure ulcers, acute care facilities have labored through quality improvement (QI) projects to decrease hospital acquired pressure ulcer (HAPU) rates.

Purpose

 Implementation of evidence based guidelines has translated into improvement at our Level 1 trauma academic medical center from 8.1% (2007) HAPU point prevalence rate to 2.19% (3Q2012).  To achieve these goals, it was necessary to move away from simple, unit based QI projects and instead facilitate sustainable reductions via organizational culture change.

Methods

Through the creation of the unit based skin champions, the HAPU strategy team and collaboration with our WOC Team, house-wide HAPU reduction strategies became comprehensive. They included: monthly prevalence studies, mandatory education for all licensed staff, ICU skin bundle, protocol driven prophylactic use of dressings, 100% pressure redistribution surfaces throughout the hospital, stretcher & OR table upgrades, electronic medical record enhancements capturing present on admission pressure ulcers, daily risk and skin assessments, heightened awareness in procedural and short stay areas, and patient education tools.

Findings

While achieving sustained reductions in HAPU over the last 10 months, our primary focus has shifted to medical device related injuries which account for 30-62% of our HAPU rate. This poster will highlight our five additional targeted efforts for 2013, to help us prepare for upcoming healthcare reform regulations.  DRG coders and WOC team collaboration for PU reporting accuracy, taking our HAPU M&M rounds to individual units ensuring wider translational reach, investigating all medical devices related HAPUs for product or policy change, assessing any potential link to HAPUs and the procedural, diagnostic or short stay areas and holding nurse managers accountable for unit acquired, avoidable pressure ulcers.