| | Preventing Pressure Ulcers (Bed Sores) at Gundersen Lutheran
Impact: Patients admitted to the hospital are in danger of developing pressure ulcers, or bedsores, when they lay in bed too long or in one position. The skin that touches the bed does not get enough blood flow and as a result a pressure ulcer forms. Pressure ulcers can become painful and lead to serious complications. Patients at an increased risk for pressure ulcers include those with quadriplegia, elderly or advanced age, femoral fracture, those requiring critical care and patients from skilled care facilities and nursing homes. Gundersen Lutheran decreased the number of patients who develop bedsores and in turn reduced the costs associated with prevention and treatment of pressure ulcers.
Aims
1. Decrease the number of patients with pressure ulcers
2. Prevent patients from getting pressure ulcers while in the hospital
3. Reduce costs associated with prevention and treatment of pressure ulcers including the costs for renting overlay mattresses.
Changes
1. Gundersen Lutheran established the Wound and Skin Care Committee.
2. The Wound and Skin Care Committee:
a. Wrote the Wound and Skin Care Manual that is reviewed annually by staff
b. Determined what products to buy to aid in wound and skin treatment
c. Standardized wound and skin care tools for assessment and documentation
d. Expanded wound and skin care education to staff at area nursing homes and community agencies four times a year
e. Targeted special populations including bariatric patients for intervention and staff education.
f. Performs on-going root cause analysis of wound issues as they arise
g. Educates staff when to replace mattresses in patient rooms as well the need to not rent overlay mattresses in addition to the new top of the line Atmos Air mattresses by KCI mattress
3. Skin Care Associates on hospital units completed National Database of Nursing Quality Indicators (NDNQI) certification.
Results
Conclusions
1. Since 1995, we decreased the percent of patients with pressure ulcers in eight years from 32% to 14% and dropped another 91% over the next four years to 1.8 %.
2. We decreased the percent of patients who developed pressure ulcers while in the hospital from 6% in 1995 to zero where it is holding steady.
3. There has been a cost savings of about $100,000 annually by renting less overlay mattresses. Overlay mattresses are no longer needed with the purchase of the top of the line mattresses at Gundersen Lutheran.
Next Steps
1. Implementation of strategies (rounding) to carry out recommendations of care in the Wound and Skin Manual in all hospital nursing areas
2. Continue with annual prevalence and incidence, and quarterly observational one day assessments.
3. Continue annual review of Wound and Skin Manual
4. Continue quarterly education to include outlying facilities
5. Continue yearly chart review for documentation
6. Continue to support expert care leaders through wound and skin care certification processes
7. Continue to decrease the number of overlay mattresses rented
Leader: You may contact the activity leader for more information if desired:
Mary Kerrigan, PT, DPT, NCS - makerrig@gundluth.org
Background
Pressure ulcers can be a common and costly problem in many health care settings such as hospitals, nursing homes, and home health care. Nationally, the number of patients who develop pressure ulcers while in the hospital range from 2.7% to 29.5% and the number of patients who have pressures ulcer ranges between 3.5% and 29.5%. Some experts estimate the nation’s annual cost of pressure ulcer treatment exceeds $1 billion. (“AHCPR Supported Clinical Practice Guidelines,” n.d.; Tiller & Wilds, 2006).
Following a 1995 study at Gundersen Lutheran, a multidisciplinary committee was formed with the purpose of addressing education, product evaluation, and research / outcomes related to issues affecting wound and skin care at Gundersen Lutheran.
Methods/Measures
1. Participation in national prevalence and incidence studies through Kinetic Concepts Incorporated (KCI).
2. All hospital patients agreeing to participate have a head to toe skin assessment done with follow-up three days later to assess for any evidence of skin breakdown.
3. Cost analysis of pressure relieving devices.
References
1. Executive Summary. In AHCPR Supported Clinical Practice Guidelines. Retrieved October 1, 2007, from http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.section.5320)
2. Tiller, S. J. & Wilds, T. A. (2006) “Skinsational Skin Care” to Reduce the incidence and Severity of Pressure Ulcers in Hospitalized Patients. Journal of Clinical Outcomes Management, 13(9), 493-500.
Acknowledgments
Collen Vollenweider RN, BSN, CWON
Patricia Anderson RN
Cheryl Strom RN, BSN
Nicole Wickus
Wound and Skin Care Committee |