Hospital-Acquired Pressure Ulcer Reduction after a Long Term Acute Care Hospital Mentoring Program

A mentoring program (MP) for administrative and clinical staff was developed to reduce the incidence of hospital-acquired pressure ulcers (HAPUs) in long term acute care hospitals (LTACHs).  LTACHs treat chronic critically ill (CCI) patients with long hospital stays in which malnutrition; limited mobility, hemodynamic instability and acute illness can contribute to HAPU development.

Following an initial administrative conference call, clinical leadership conducted calls to review causes of high pressure ulcers rates, including program adherence, formulary-based prevention strategies, workflow, wound etiology, and understanding/adherence to reporting guidelines. Action plans were developed to address the deficits. HAPU rates were the number of HAPUs divided by patient days times 1,000. HAPU rates were compared 6-months pre- and 6-months post- MP implementation in 9 MP and 9 randomly selected control group LTACHs. A General Linear Model with repeated measures was used to determine the significance of the mean HAPU rate changes

For the 9 MP LTACHs, the average HAPU rate decreased from a pre-implementation rate of 6.09 HAPUs [95% CI: 4.98, 7.20], to a post-implementation rate of 2.78 HAPUs [95% CI: 1.08, 4.49] (GLM repeated measures design; F (1, 8) = 17.025, p = .003; partial eta squared = .680). A control group of a random sample of 9 LTACHs that did not participate in the MP program had no significant change in HAPU rates pre- to post- MP implementation.  Overall average HAPU rate from the MP LTACHs began declining prior to implementation of the MP but decreased at a more rapid rate following MP implementation.

A mentoring program drilled down into causative factors associated with elevated HAPU rates was shown to be successful in significantly reducing HAPU rates in LTACHs that had a history of elevated HAPU rates.  Similar programs may be effective in reducing HAPUs in high acuity and other critical care settings.