Executive Summary (Benchmark Assessment)

Hospital Acquired Pressure Ulcers (HAPUs) Prevention
“Hospital-acquired pressure ulcers were shown to be an important risk factor associated with mortality,” per Dr. Courtney Lyder, of the UCLA School of Nursing. “It is incumbent upon hospitals to identify individuals at high risk for these ulcers and implement preventive interventions immediately upon admission.” Pressure ulcers, also known as bedsores often occurs when patients have limited mobility and unable to reposition themselves in bed causing injury caused by pressure, friction and moisture. Sometimes these injuries can also be caused by variety of tubes, drains, and other equipment in use. Purpose of the Program

The Medical Center is starting a new initiative dedicated to the prevention of pressure ulcers in acute care facilities. Hospital-acquired pressure ulcers (HAPUs) are a national concern due to increased morbidity, climbing treatment cost, and decreased reimbursements. The Centers for Medicare and Medicaid Services (CMS) considers pressure ulcers to be preventable. Hospitals are already facing low reimbursements and penalties from Medicare related to the ulcer specific care of patients who acquire pressure ulcers during their inpatient stay. Pressure ulcer prevention in acute care hospitals is surely not new, but it is a highly sensitive issue focused by several recent papers and reports (Zaratkiewicz, S, etal, 2010). The frequency of occurrence and rising cost of treating pressure ulcers is prompting health care industry to identify and implement interventions in order to prevent HAPUs.

In the past, nursing units were responsible for the care and prevention of pressure ulcer care but the current studies have proved that pressure prevention and management needs multidisciplinary approach (AHRQ, n.d). Effective pressure ulcer prevention practices require educating patients and health care providers in prevention techniques. In addition to identification and prevention, there are products that can be used in order to prevent occurrence of HAPUs. The purpose of this project is to implement use of foam dressing called Mepilex Border proven to help prevent pressure ulcers when used in addition to the prevention protocols by redistributing pressure, reducing friction, and providing an optimal microclimate. It combines antimicrobial action of ionic silver with soft silicone adhesive providing healing and reduced pain (Barrett, 2009). Mepilex dressing can be repositioned after skin assessment making it easy to assess the wounds without need for reapplying new dressing after each assessment. The Target Population or Audience

This report is presented as coordinated multidisciplinary approach. Persons involved would be representatives from board of directors, Materials Management, Physician and a Quality and Improvement team. Purpose of the presentation is to implement use of Mepilex Border Dressing throughout the hospital in order to prevent hospital acquired pressure ulcers. According to Agency for Healthcare Research and Quality (AHRQ), 90% of all pressure ulcer related hospitalizations are due to secondary pressure ulcer diagnosis, 72% of patients are 65years or older and about 60,000 patients die each year as a result of a pressure ulcer. Some states legislation has declared secondary pressure ulcer as elderly abuse not covered by malpractice insurance. Fluid and nutrition disorder and dementia is the primary reason for hospital admission with pressure ulcers for adults over 18years. Therefore the target population here would be anyone over 18 admitted with debilitating condition should be examined and monitored closely for pressure ulcers. Benefits of the program

The overall purpose of the project is to prevent complications and cost associated with HAPUs. The Mepilex dressing system will be initiated for the purpose of preventing the occurrence of new and progression of the existing ulcer to advance stages. According to the international Journal of Tissue Repair and Regeneration, Mepilex brand dressing reduces pain and also aids in the ulcer healing at 67% compared to other brands. (Frands & Moody, 2007). Mepilex dressing effectively absorbs and retains exudate and maintains a moist wound environment. The Safetac (soft silicone nonstick dressing that does not stick to the wound) layer seals the wound edges, preventing the surrounding skin from the risk for maceration. The Safetac layer reduces pain and makes it easy to change the dressing without affecting the wound or surrounding skin. The Cost or Budget Justification

Acquired Pressure ulcers during hospital stays have been known to cause increase length and cost of inpatient stays along with treatment and recovery delays. According to Agency for Healthcare Research and Quality (AHRQ), 2.5million patients are affected by pressure ulcers per year costing up to $11.6 billion per year in the United States. Individual cost of care per patient can go up to $151, 700. According to a study of the patients who acquired pressure ulcer while in the hospital conducted by UCLA , bedsores were mostly found on sacrum, than hips, buttocks and lastly on the heels. The study also discovered that out of 3,000 patients who were admitted with a pressure ulcer, 16.7 percent developed one new ulcer on a different part of their body during the hospital stay.

When initial assessment identifies the risk factors, an immediate warning signal should be sent identifying the appropriate steps taken to minimize the occurrence of pressure ulcers (UCLA, 2012). Medicare estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay. According to Molnlycke Health Care, its costs about $82 per patient per average hospital stay of 10 days and wear time of 3 days for the Mepilex dressing. Therefore it would be a cost effective approach to reduce and prevent occurrence of HAPUs. Evaluation of the Project

According to basic principle of quality, if it cannot be measured, it can’t be improved. Therefore, bedsore/pressure ulcer incidence must be tracked as a quality improvement program to evaluate the effectiveness of interventions performed in order to find out whether the incidences is improving, worsening or staying the same in response to the collaborative efforts. Daily comprehensive skin inspection should be documented on a standard form. The collected information should be than reviewed to evaluate the effects of interventions. Recommendation would be to reevaluate the economic and patient care impact within a year.

References

Barrett, S. (2009). Meplix Ag: An antimicrobial, absorbent foam dressing with Safetac
technology. InterNurse, 18(20), S28-S36.
Franks, P. J., & Moody, M. (2007). Randomized trial of two foam dressings in the management of chronic venous ulceration. The International Journal of Tissue Repair and Regeneration, 15(2), 197-202 Lyder, C.H., Wang, Y., Metersky, M., Curry,M., Kliman, R., Verzier,N.R., Hunt, D.R. Hospital- Acquired Pressure Ulcers: Results from the National Medicare Patient Safety Monitoring System Study. Journal of the American Geriatrics Society, 2012; 60 (9): 1603 DOI: 10.1111/j.1532-5415.2012.04106.x Preventing Pressure Ulcers in Hospitals (n.d) A Toolkit for Improving Quality of Care, Retrieved from University of California – Los Angeles. (2012, October 2). Hospital bedsores linked to patient mortality. ScienceDaily. Retrieved May 4, 2014 from www.sciencedaily.com/releases/2012/10/121002092845.htm Zaratkiewicz, S., Whitney, J. D., Lowe, J.R., Taylor, S., O’Donnell, F. and Minton-Foltz, P. (2010)Development and Implementation of a Hospital-Acquired Pressure Ulcer Incidence Tracking System and Algorithm, Journal for health care quality, 32(6), 44-51.