"Zero Tolerance" Program for Facility Acquired Pressure Ulcers (FAPU)

Engaging the interprofessional team in a "Zero Tolerance" Facility Acquired Pressure Ulcer (FAPU) Prevention Program System-wide facilitates commitment, ownership and empowers nurses to "Champion" quality, cost-effective care. Pressure Ulcers (PrUs) are a major health care issue in the U.S. impacting approximately three million adults annually. Facility Acquired Pressure Ulcer (FAPU) incidence rates range from 0% to 53.4% and U.S. treatment costs range between $37,800 to $70,000/ulcer. The purpose of this study was to investigate Facility Acquired Pressure Ulcers (FAPUs) in two community hospitals in upstate New York while implementing the "Zero Tolerance" Program. 

A review of 25 FAPU prevalence studies from 2007 to 2015 was conducted based on 3,937 patients in two hospitals in upstate New York. A Root Cause Analysis (RCA) was conducted for each FAPU. The FAPU rate for both hospitals ranged from .06% to 6.1% during the eight year period. The average rate of FAPU for the eight year period was 2.7% which is LOWER than the National 2015 FAPU reported rate of 3.6% based on 95,951 patients. The FAPU rate has DECREASED across both hospitals during the eight year time period. Root cause analysis revealed common FAPU sites (coccyx, sacrum and heels) consistent with current national research findings. Limitations included a convenience sample of two acute care community hospitals in a multi-institutional health care system. FAPU prevalence data is essential in analyzing rates and trends including Root Cause Analysis (RCA) to improve evidence-based practice in PrU prevention and management, and to reduce costs. In addition, retrospective and concurrent data can be used to establish institutional benchmarks to align with National “Best Practices” to reduce FAPUs. Program interventions include electronic health record (EHR) protocols, documentation, continued quarterly data collection and analysis of FAPU prevalence and relationships between RCAs, Braden risk scores and FAPUs.