Background – Harm Incidence of Stage II or greater > Hospital- Acquired Pressure Ulcers ranges from 5% - 9% 60, 000 die from pressure ulcer complications each year
Background – Harm Decrease quality of life and functionality Increase risk of other complications Increase hospital mortality Increase need for skilled care and rehab after discharge
Who get’s pressure ulcers? Spinal cord injuries & elderly Higher incidence in hospitals (38%) not nursing homes (23.9%) Pressure ulcers do not always signify poor care Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296:974-984.
AIM Reduce the prevalence of hospital acquired Stage II or greater pressure ulcers from 2010 baseline rate by 50% by December 31, 2013
Suggested Measures Outcome Patients with at least one Stage III or greater hospital acquired pressure ulcer Process Skin assessment documented within 24 hours of admission HAPU risk assessment completed within 24 hours of admission
Turn! Turn! Turn! Turn & reposition at least every 2 hours
Pressure Relieving Special Surfaces & Tools Foam wedges to position patients Special pressure redistributing/relieving mattresses Use pillows only for limbs Heel boots
Early Mobility & Ambulation Staff driven protocolGet patients moving! Includes assessment of patient strength & weaknesses Includes ‘opt out’ for contraindications Triggers referral to physical therapy based on criteria
Minimizing Shear & Force Use lifts to reposition Breathable glide sheets Limit linen layers to no more than 3 Foam sacral dressing
Key Resources AHRQ Toolkit: Preventing Pressure Ulcers in Hospitals AHRQ Guideline Synthesis on Preventing Pressure Ulcers National Pressure Ulcer Advisory Panel IHI: How to Guide on Reducing Pressure Ulcers Hughes RG (ed). Patient Safety and quality: An evidence- based handbook for nurses. AHRQ Publication No. 08-0043, Rockville, MC: Agency for Healthcare Research and Quality; April 2008 Gibbons W, Shanks HT, Kleinhelter P, Jones P. Eliminating facility-acquired pressure ulcers at ascension health. JC J Qual Pt Safety. 2006;32(9).488-496.