The Effect of Surface Replacement Program to Decrease Hospital Acquired Pressure Ulcers in Medical-Surgical Units

Background: In 2006, the Centers for Medicare and Medicaid Services(CMS) identified Hospital Acquired Pressure Ulcer (HAPU) as a "never event". This lead to reimbursement restriction to HAPU's related treatment. The increase number of HAPU's, financial impact of the reimbursement restrictions, and high cost of specialty surface rental for pressure ulcer prevention generated urgency from senior leadership of a community hospital to implement a comprehensive pressure ulcer prevention program which instituted a low air loss bed replacement program. 

Design and Methods:This study employed a retrospective chart review of HAPU occurences on the year before implementation and a year after the program was implemented. Statistics reported through Quality Management Services through a monthly pressure ulcer incidence studies were utilized. Data collected included the stage of pressure ulcer and the clinical area where the HAPU was developed. A pressure ulcer incidence rate was entered through MED-CALC. 

Intervention: There were 5 medical surgical units included in this study. All 5 medical surgical units that had the traditional foam hospital mattress were replaced with 190 low air loss mattresses. A Low air loss mattress is a support surface that redistributes pressure. This change was conducted due to a high incidence of HAPU's one year prior to implementation. 

Results:A total of 67 HAPU's identified one year prior to implementation, a year after the replacement program was implemented, there were 28 HAPU's discovered. Pre-implmentation incidence rate was 0.04373, one year post implementation incidence rate was 0.01859, p=0.0001, and 95% CI 1.4925 to 3.7984. There was a significant decrease in HAPU one year post implementation.