O29 – Sustainability of a Hospital-Acquired Pressure Ulcer Prevention Bundle In Surgical Patients
Author(s):
Background: Hospital-acquired pressure ulcers (HAPU) are associated with significant morbidity, mortality, and cost. However, HAPU represent a potentially preventable condition. On initial investigation, an evidence-based HAPU prevention bundle (HAPU-B) was prospectively implemented with a reduction in HAPU rates in the first 6 months. We propose that HAPU-B can result in sustained decreased HAPU rates.
Hypothesis: Implementation of an evidence-based HAPU-B can result in an early decrease in HAPU rates that is sustainable.
Methods: A multidisciplinary prevention team created an evidence-based HAPU-B. Risk was assessed using the Scott Triggers (Age >62 Albumin<3.5 ASA >3 Surgery>3 hrs). From August 2012, for high risk patients (≥2 triggers), the HAPU bundle was applied:1)Comprehensive skin assessment on admission, transfer and discharge 2)Placement on OR beds with pressure-redistributing mattress; careful positioning and padding of pressure points 3)Scheduled q2h turns with pressure points relief by adjusting devices, massage of bony prominences, pillows, heel pads, or wedges 4)Prevention hand-off between providers 5)HAPU assessment on daily rounds. Unit specific HAPU rates on the surgical service were collected 6 and 14 months post-HAPU-B and compared to rates at 6 month pre-HAPU-B implementation. Student’s ttest and Chi square test were used for statistical analysis.
Results: Daily HAPU-B checklists were used high-risk patients admitted to the surgical service. Six months after implementation, the mean surgical HAPU rate decreased from 3.37±0.19 to 1.45±0.33,p=0.004. During the same time, mean VHA HAPU rate was unchanged (1.84±0.31 to 1.85±0.06,p=NS). By unit, the HAPU rates significantly decreased (ICU:Pre=2.93±0.9,Post=1.25±0.7;Ward: Pre=2.93±0.6, Post=0.83±0.3, p=0.019). At 14 months post-implementation, HAPU rates remained at lower levels (Fig. 1).
Conclusions: Implementation of an evidence-based HAPU-B resulted in significantly decreased HAPU rates on the surgical service. The reduced rates were sustained 14 months after implementation.