Achieving Success by Refining the Pressure Ulcer Prevention Program in the LTAC Setting

BACKGROUND:   Minnesota was the first state to mandate reporting of full-thickness hospital acquired pressure ulcers (HAPUs).  Our long term acute care (LTAC) facility has been collecting data annually.  In 2012, our LTAC had 8 reportable HAPUs. 

PURPOSE:  The high number of HAPUs and quarterly incidence rates trending up concerned nursing leadership and WOC APRNs.  This prompted us to review our current practices related to pressure ulcer (PU) prevention.  We compared our practices to best practice guidelines.  Gaps to our program were identified and our improvement plan was developed.   

OBJECTIVE:   In FY12 our PU goal rate was <4.35%, with P&I studies conducted quarterly.  We increased studies to monthly after a high March rate of 6.25%.  In April, during our hospital-wide huddles, we implemented concurrent reporting; tracking all HAPUs and their state-of-healing.  This was reported to leadership by each unit charge nurse.  In July we had a 3-day performance improvement event that focused on patient turning.  The expectation was that all patients with a Braden mobility subscale score < 2 would be turned every 2 hrs.  This work included development of a refusal algorithm.   The acronym STAR was the team’s moto.  The turn must be (S)cheduled, involve (T)eaming, hold staff (A)ccountable with (R)eal time documentation.  A few additional areas the team worked on included standard work associated with heel off-loading, therapeutic settings of our hospital-owned specialty beds and stabilization of NG/NJ tubes that allowed for skin inspections.                                                        

OUTCOMES:  Our FY13 incidence goal was 4.88% yet as of August 2013, one year later, our cumulative monthly PU incidence rate dropped to 2.47%, which demonstrated a significant improvement in our process.  This year long process, although challenging at times, resulted in a redefined program and a significant decrease in our rate of HAPUs and 50% reduction of our reportable HAPUs.