The use of LEAN to drive pressure ulcer prevention in long-term care

Background:

Pressure ulcers, whether present on admission or facility-acquired, are costly to treat and are associated with increased morbidity and mortality.  Evidence-based guidelines for pressure ulcer prevention are available to long-term care (LTC) facilities. However, identification of  which interventions are best suited to the individual facilities and across systems, as well as development of standardized implementation strategies is a challenge. Lean is a process that can assist with individualizing as well as standardizing care in long-term care facilities.

Objectives:

1. To determine overall prevalence and incidence of PU across all LTC facilities in the integrated health system as a benchmark for the project.
2. To identify which strategies are currently being used in the health system long-term care facilities, standardize and ultimately improve pressure ulcer prevention strategies in LTC settings across seven long-term care facilities in a recently integrated healthcare system .

Method: A prevalence and incidence study was performed in all seven skilled nursing facilities in a recently integrated health system within a simultaneous time frame of four days in June 2013. A total of 567 patients were surveyed. Data from the study was analyzed and brought to an interdisciplinary team from all seven facilities. Using the Lean process analysis and DMAIC Model (Define, Measure, Analyze, Improve, Control), the team was able to identify root causes and work-flow processes across all seven facilities. This led to standardization of PU prevention strategies for all long-term care facilities in the system.

Results: Facility-acquired pressure ulcer rates have decreased in all long-term care facilities across the health care system. Standardization of PU prevention strategies have been achieved. The WOC nurse continues to work closely with the interdisciplinary team to problem solve with each individual facility using the DMAIC model.