Decreasing hospital-acquired pressure ulcers among patients with acute hip fracture in the acute-care setting

Background: At our 338-bed acute-care facility, 8 patients with acute hip fracture developed 13 hospital-acquired pressure ulcers (HAPU’s) in 2013. 6 of the 8 patients who developed HAPU’s were admitted to our hospital’s 37-bed Ortho-Surgical unit. Pressure Ulcers decrease quality of life and increase health care costs. Annually, 60,000 deaths are estimated to be associated with complications from pressure ulcers. In 2008, Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospitals for costs related to HAPU’s.

Methods: The purpose of this project was to identify if the implementation of a new evidence-based pressure ulcer prevention protocol that includes 1) hip fracture specific interventions, and 2) staff education, would decrease or eliminate HAPU’s for patients receiving care for acute hip fracture. An evidence-based pressure ulcer prevention protocol specific to hip fracture patients was developed and implemented. After an assessment of organizational readiness, facilitators and barriers to change were identified. An Evidence- Based Practice (EBP) team was assembled to address barriers, and included the three Wound, Ostomy and Continence (WOC) nurses, the Orthopedic Nurse Practitioner and the Ortho-Surgical Unit manager. The WOC nurses provided recommendations to prevent pressure ulcers, educated staff and consulted on patients, the Orthopedic Nurse Practitioner updated the Hip Fracture PUP Protocol with specific pressure ulcer prevention measures and educated staff, and the manager provided budgetary and administrative support.

Outcomes and Implications: Two HAPU’s developed in patients admitted with a diagnosis of acute hip fracture in 2014, which represents an 85% decline from the prior year. For 2015, through October, one patient with a diagnosis of acute hip fracture has developed a HAPU. These outcomes support similar targeted pressure ulcer prevention interventions for other high-risk populations.