Summary

A Clinical Practice Improvement study was conducted at a hospital in the Rocky Mountain West to determine if development of pressure ulcers (PUs) is related to the severity of illness of the patient, and if implementation of a protocol to stabilize the process of care for prevention of PUs reduces the incidence of PUs. Results show that patients who developed PUs were sicker on average on admission than patients at risk who did not develop PUs. Following implementation of the PU prevention protocol, PUs decreased 300 per year, saving $1.268 million per year.

Primary Objectives

Determine whether development of PUs is related to patient severity of illness, and if implementation of a protocol to stabilize the process of care for prevention of PUs reduces their incidence.

Methods

1. Using as a framework the Clinical Practice Guideline No. 3, Pressure Ulcers in Adults: Prediction and Prevention, published by the US Agency for Health Care Policy and Research, hospital personnel developed a protocol that set forth the detailed interventions to be performed for each level of the six subscales in the Braden Scale.
   

2. A separate PU treatment protocol defined a uniform staging system for PUs and detailed interventions for each stage.
   

3. A one-hour inservice program was used to train nurses to use the protocols.
   

4. The Comprehensive Severity Index (CSI^â ) software system was used to stratify patients for analysis on the basis of severity of their underlying illness on admission.

Results

1. Patients who developed PUs were sicker on average on admission than patients at risk who did not develop PUs.
   

2. The existence or development of a PU predisposed a patient to greater illness.
   

3. Neither the treatment protocol nor the prevention protocol recommended the use of low air-loss specialty beds.
   

4. Following implementation of the PU prevention protocol:
   

• PUs decreased by 300 per year,
  

• the use of low air-loss specialty beds decreased 45%, and
  

• $1.268 million per year saved.

Impact

Following implementation of the PU prevention protocol, PUs decreased; $1.268 million per year was saved; and the use of low-air-loss specialty beds decreased 45%. The study cost less than $100,000.