Reduction in Rental Bed Usage while Reducing Hospital Acquired Skin Breakdown

Purpose:
As an organization, we are committed to staying below the national benchmark of 2 to 5 hospital-acquired pressure ulcers per 100 admissions, while at the same time reducing the usage of rental beds and support surfaces.

Significance:
Prevention of hospital acquired pressured ulcers has proven to improve the patient experience as well as patient outcomes. Wayne Memorial Hospital's goal was to provide appropriate bed surfaces, as well as cost containment related to bed rentals.

Strategy and Implementation:
A multidisciplinary workgroup was developed. This monthly workgroup initiated performance improvement strategies related to skin assessment and bed utilization. Assessment changes included new skin assessment tools including “skin assessment” performed on admission and daily, and a daily “skin risk assessment". In addition,a decision process was developed related to the need for bariatric and/or specialty beds. Criteria for use of bariatric rental beds included the physical assessment of the patient's height, weight, abdominal girth, the ability to turn the patient side to side, and turning surfaces. This workgroup was also involved in the assessment of our hospital owned beds including size and surfaces. Available bariatric beds were evaluated for possible purchase and/or rental. Education was provided at staff meetings and during orientation about our new processes. A monthly newsletter was developed to facilitate education regarding skin care.

Evaluation:
From 4th Q CY 2009 to 3rd Q CY 2011 skin breakdown rates excluding ICU decreased from 1.6 to 0.3 per 100 admissions and including ICU results remain below the benchmark from 1.9 per 100 admissions to 0.4. Bed rental cost decreased from $155,291 in 2010 to $44,951 in 2011.

Implications for Practice:
A collaborative process by the physician, wound care nurse, and nursing staff, was established for the assessment of the patient to determine the appropriate need for a specialty bed, which reduced cost and prevented skin breakdown.