Healthcare News & Insights

Successful strategy for reducing pressure ulcers

Pressure ulcers in patients are a prevalent and costly problem for hospitals. And because they’re seen as “never events” in some cases, Medicare won’t always reimburse facilities for treating them. To cut back on pressure ulcers, one hospital decided to implement a comprehensive prevention program – and other facilities can learn from its success. 

ThinkstockPhotos-465497005Three years ago, nurses at Eskenazi Hospital in Indianapolis decided that they would change their approach to pressure ulcers.

As described in an article from Medscape, staff previously saw pressure ulcers as inevitable, especially for critical care patients who had limited mobility.

But given that Medicare had stopped reimbursing hospitals for treating late-stage pressure ulcers and that the average cost of treating a pressure ulcer was close to $39,000 per patient, Eskenazi decided to find out if it could save costs and boost outcomes for patients prone to pressure ulcers.

So at the beginning of 2014, the hospital started its “Save our Skin” pilot project in the intensive care unit.

Multifaceted strategy

The initial goal of the Save our Skin project was to cut the occurrence of pressure ulcers in half after 12 months. A comprehensive look at the project was published in the American Journal of Critical Care.

As part of the project, nurses used specific protocols designed to prevent pressure ulcers. Patients were grouped into risk categories under the Braden Scale to determine the likelihood they’d develop an ulcer. Nurses followed specific guidelines when treating patients in each category.

In addition, the hospital revised its general skin-care protocol to emphasize preventive, proactive care to nip ulcers in the bud before they developed. New products were added to nurses’ regimen to keep small skin care issues under control for patients.

And one of the most significant changes involved changing how nurses reposition patients in their beds.

A big part of preventing pressure ulcers in patients with limited mobility is making sure they change positions regularly so one area isn’t taking constant pressure from body weight.

Before, nurses had to shift and position patients without assistance. But as part of the program, the hospital purchased fluidized positioners that could be placed behind the torso to offset the pressure on patients – and make it easier for nurses to turn and reposition them when necessary.

Staff received regular education about proper skin care as well. Before the program began, they were trained on all new protocols. Afterward, the care team performed weekly “skin audits” to make sure all staff were compliant with the new procedures. Any instances of ulcers were posted in the ICU, and staff who did well with prevention were rewarded.

To boost its results, Eskenazi began using special silicone adhesive dressings for patients with a moderate to high risk of developing pressure ulcers. The dressings were placed on common pressure points, including the sacrum, heels and elbows. They were used as a preventive measure for up to a week per patient.

Meeting the mark

By the end of the first year of the project, the hospital reached its goal of reducing pressure ulcers by 50%. And it continued to be successful over the following two years. In fact, according to Medscape, it’s saved an estimated $700,000 each year by preventing pressure ulcers.

After three years, the hospital’s reduced pressure ulcers by 69% and eliminated cases of the late-stage pressure ulcers Medicare won’t cover. This was despite experiencing a 22% increase in patients visiting the ICU.

There was even good news for patients who, despite nurses’ best efforts, ended up developing a pressure ulcer. Over the course of the project, length of stay for these patients declined every year – likely due to the proactive approach the hospital takes to pressure ulcers in general.

Prevention for hospitals

With pressure ulcers on the growing list of standards for determining a hospital’s quality of care, hospitals should take a second look at how their staff perceive pressure ulcers, as well as the steps they’re currently taking to prevent them in patients.

As shown by Eskenazi’s success, the best approach to this issue is to tackle it head on, closely monitoring and evaluating staff to make sure new habits and training stick.

The Agency for Healthcare Research and Quality (AHRQ) has a comprehensive toolkit hospitals can use at any stage of developing a pressure ulcer prevention program. And more information about the Save our Skin project is available on the website for the American Association of Critical Care Nurses.

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