Professional Practice-Implementing a Pressure Ulcer Prevention Program

Abstract

Intermountain Healthcare (IH) has demonstrated a fourfold (12.8 to 3.2) reduction in hospital-acquired pressure ulcers (PrU) through a collaborative and iterative process from 2005 to 2008. IH is a healthcare system located in Utah and Idaho with 20 Urban and Rural Acute Care Hospitals. IH has over 2500 beds and admits over 120,000 inpatients for 500,000+ patient days. IH's mission is to provide “excellent healthcare services to the communities in the Intermountain region.” In addition, several facilities have achieved ANA Nursing Magnet recognition during this time. Our process improvement initiative was led by a multidisciplinary system-wide team including champion teams at each facility. The system team has standardized care protocols, wound and skin care products (dressings, lotions, skin protectants, etc), mattresses, and clinical education. Collaboration with multiple vendor partners for products and education allowed IH to achieve significant improvement. Examples of partnership and standardization include purchase of pressure relieving support mattresses for all general medical surgical beds that yielded an immediate reduction of PrUs from 10.3, in first quarter 2006 to 4.5 by year end. Additional gains based on standardization of wound and skin care clinical protocols, products, and required education have yielded a continued reduction of PrU to an average quarterly prevalence rate of 3.6 (third quarter 2008 was 3.2). Examples of protocols include; pressure ulcer prevention guideline, PrU staging and assessment, skin care and assessment, acute wound care, chronic wound care, paper-charting forms, computer-charting screens, etc. Examples of products include; dressings, lotions, tapes, soaps, protectants, and barrier creams. Examples of education include focus on standardization with; posters, flyers, campus-specific work shops in partnership with preferred product vendors, and required online training through IH's learning management system for PrU assessment, staging, wound care, skin care, PrU prevention.