Rising to the Surface: A Successful 3 Year Journey

Purpose:
Identify surface usage,review pressure ulcer prevention tactics as related to surfaces,and assess staff knowledge related to surfaces.Develop a protocol for ordering and discontinuing surfaces,reduce the rate of HAPU while implementing a cost effective strategy focusing on the use of surfaces.

Significance:
Coupled with high cost of surface rental and the need for continued HAPU prevention,we were challenged with devising strategies to implement a cost effective prevention program focusing on decreasing the use of surfaces in our acute and critical care areas while maintaining a low HAPU rate.

Strategy and Implementation:
DHMC used Toyota LEAN model:integrating identification of initial state, target condition, gap analysis, solution approach, rapid experiments, and plans for completion. The Rapid Improvement Event revealed gaps in workflow of surface usage including lack of knowledge of bed assets, absence of written protocol based on patient risk, limited resources with labor intensive inventory, education deficits, and no standard work for ordering beds. The team implemented a plan that included: gatekeeper functions for ordering beds, standardized decision making for patients for specialty surfaces, systematic computerized tracking, and increased standardization by reducing the bed formulary, and staff education and communication plan. Data collection and analysis has been ongoing. The ratio of adult specialty bed days and related costs are monitored monthly, while hospital acquired pressure ulcer rates are followed quarterly using NDNQI pressure ulcer data collection guidelines.

Evaluation:
Total yearly cost of surface rental in 2007:$227,689.After interventions, 2009 yearly cost:$92,829, then 2010 yearly cost:$82,563. Total cost reduction of 63.7% over the three year period. Yearly HAPU results using NDNQI quarterly data collection methods:2007:5.40%;2008:13.06%;2009:3.24%;2010:3.85%.

Implications for Practice:
Pressure reducing surfaces can be applied as a comprehensive pressure ulcer prevention plan, however inappropriate use of surfaces can be costly with little benefit to patients. By providing the “right” bed for the “right” patient,cost effective care with low HAPU rates is attainable.