Improving Educational, Clinical and Economic Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP) at a 560 bed multi-specialty, Acute Care Health System in South East, FL

More than 2.5 million individuals in the United States develop Pressure Ulcers (PU’s) yearly. PU’s are associated with distress, increased morbidity and mortality and health care costs. Pressure Ulcer Prevention Program (PUPP) practices are ongoing and an important challenge in acute care hospitals. High quality pressure ulcer (PU) prevention requires an organizational culture and operational practices that promotes innovations for improvement. 

Our study sought to implement and evaluate the effect of (1) clinical education related to PUPP among Licensed Nurses and Certified Nursing Assistant’s (CNA’s), (2) the utilization of an advanced skin care system to include a phospholipid-based skin cleanser, a nutrient-based moisturizer and a silicone-based moisture barrier and (3) the utilization of a high absorbency dry flow pad on reducing Hospital-Acquired Pressure Ulcers (HAPU’s).

A pretest was administered to 648 Licensed Nurses and 289 CNA’s to establish their baseline knowledge related to a PUPP. Following clinical education on PUPP, a post test was administered. A new skin care product regimen was implemented hospital wide. The data compared pre and post PUPP education, implementation of an advanced skin care system and high absorbency dry flow pads to determine the effectiveness of the PUPP.

This study was conducted utilizing monthly Pressure Ulcer Prevalence Surveys to obtain HAPU rates. After 4 months of implementation, zero PU incidents were reported versus 11 PU incidents reported as the base incident count. PU incidents remained below the base incidents count for the following 8 months. PUPP test scores increased 30% for the Licensed Nurses and 27% for the CNA’s. When evaluated with the added expense of PU treatment using the Centers for Medicare and Medicaid Service (CMS) guidelines on the estimated cost of $43,180 per patient to treat one PU case, cost savings were estimated at $3,152,140 for the year 2012.