Prophylatic Dressings for Pressure Ulcer Prevention in Long Term Care

Challenge -- In House Acquired Pressure Ulcers (IHAPUs)

• August, 2013: Facility - acquired pressure ulcers = 4% to 5% (118 PUs in 49 communities)
• No company- wide pressure ulcer prevention (PUP) plan for residents in skilled care - reactive vs. proactive
• Supply rooms: Inconsistent availability of PUP products
• The need for buy - in from community staff
• Cost to treat pressure ulcers -- reported as $500 to $70,000 per ulcer - $11 billion annually in the US Plan -- Pressure Ulcer Prevention Plan
• My company had established a goal of ≤ 2% IHAPUs
• Identified products for skin and wound care management
• worked with manufacturer representatives to develop quick reference guides and education about product use
• developed and implemented other PUP interventions

Implementation of Plan: October 2013 for all 49 communities

Protection and Prevention for all residents

• On admission to skilled setting, Long term care or rehab all residents receive
• A set of skin care products depending on their individual need; ph. balanced hair and body wash, cleanser, moisturizer, barrier ointment or cream (bed confined, wheel chair confined) receive a kit and the ambulatory receive a kit
• silicone adhesive hydrocellular foam dressing applied to boney prominences depending upon individual identified risk factor ( Pressure Ulcer Risk tool identifier of ≤ 16 or any sub-score identifier placing the resident at risk)
• Orders for silicone adhesive hydrocellular foam dressing established to be written for prevention; assess dressing, surrounding skin and skin under dressing q shift and PRN for dislodgement
• Dietary consult for Nutrition for all at risk residents, new pressure ulcers, change of condition, and if resident is admitted with PU/s
• Turning frequency
• Support Surface/device
• Clinical Judgment

Results:

December 2013:

75 IHAPUs

June 2014

Company 0.62% IHAPUs