Dollars, Collaboration, and Pressure Ulcer Pressure (PUP): Saving Upwards of a Million by Achieving Zero

The incidence of hospital acquired pressure ulcers (HAPU) plateaued at a rate of 7.8% in two critical care units despite a prevention bundle, which included risk and skin assessment, moisture management, and offloading. Additionally, respiratory medical device related pressure ulcers notably increased to 3.7%.  At a facility expense ranging from $500 to $70,000 per pressure ulcer, an incidence of two per month could cost the hospital a maximum of $1.68 million annually. Through a collaborative approach, the aim of this quality improvement project was to determine if utilizing prophylactic silicone foam dressings would reduce the incidence of pressure ulcer development, hence result in cost savings for the facility.

            An interdisciplinary team of WOC nurses, critical care nurses, and respiratory therapists utilized the plan-do-check-act quality improvement cycle. Clinical parameters for inclusion as high risk, requiring prophylactic dressings were: Braden score of 13 or less, vasopressor, high flow nasal cannula, noninvasive ventilation, tracheostomy, localized tissue edema, immobility and previous pressure ulcer. The team was educated on correct scoring of the Braden scale, the impact of vasopressor medications on pressure ulcer development, dressing application and mode of action related to prevention. Patients were assessed using an info graphic developed by the team that contained inclusion criteria and dressing selection. Data was gathered using pressure ulcer incidence per one thousand patient days for six months.

            Prophylactic silicone foam dressings to the sacrum, heel, and under respiratory medical devices as an adjunct to the current pressure ulcer prevention (PUP) bundle yielded a zero incidence rate, resulting in a potential cost savings of $840,000 biannually. Recommendation for modification of the PUP protocol was submitted to, and accepted by, Shared Governance Councils, inclusive of; algorithm for utilization of prophylactic silicone foam dressings, specific interdisciplinary roles, annual competency training, and revision of clinical documentation to reflect recommended interventions.