Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics.

Amparo Cano,Lori Lupe,Jennifer Lopez,Hope Stamp,Fortunata Joaquin,Debbie Anglade,Daniel Young,Steven Schmidt

doi:10.3390/healthcare3030574

Abstract

A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH) in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU) at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC) nurse and support staff were hired. These initial interventions resulted in a decrease in the prevalence of HAPU at UMH from 11.7% of stage II to IV ulcers in the second quarter, 2009 to 2.1% the third quarter. The rate remained at or near the 2009 UMH benchmark of 3.1% until the first quarter of 2012 when the rate rose to 4.1%. At that time new skin products were introduced into practice and continuing re-education was provided. The rate of HAPU dropped to 2.76% by the second quarter of 2012 and has remained steadily low at 1%–2% for nine consecutive quarters.

Highlights

In the United States, the occurrence of pressure ulcers (PU) annually affects as many as 2.5 million patients and the development of these pressure ulcers may lead to devastating consequences for patients that significantly reduce quality of life and which may increase mortality [1,2]
The University of Miami Hospital (UMH) is a 560 bed Acute Care Academic Medical Center located in the Health District of Miami, FL
The UMH hospital-acquired pressure ulcers (HAPU) committee retained oversight of the pressure ulcer program and facilitated all pressure ulcer initiatives related to evidence-based practice in the management and prevention of HAPU at UMH

Summary

Introduction

In the United States, the occurrence of pressure ulcers (PU) annually affects as many as 2.5 million patients and the development of these pressure ulcers may lead to devastating consequences for patients that significantly reduce quality of life and which may increase mortality [1,2]. Hospital admissions due to PU are 75% higher than admissions for any other medical conditions and the consequences of PU development in hospitalized patients are dire. Patients with HAPU experience increased lengths of hospital stays by 7–10 days and are three times more likely to be discharged to long-term care facilities, and mortality of these patients is twice that of patients without HAPU [3,4,5]. HAPU is a common medical complication in the acute care setting with rates between 5% and 6% [6]. Higher rates of HAPU were found in patients in Spinal

Methods

Results

Discussion

Conclusion