Decreasing Unit-Acquired Pressure Ulcers and Healthcare Worker Injury
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Implement a new protocol for repositioning patients through education and the use of a new repositioning device. Measure effectiveness by monitoring protocol compliance, facility acquired pressure ulcers (FAPUs) and healthcare worker injuries (HCWI) related to patient repositioning.
Relevance/Significance:
A 6-month audit on FAPUs and HCWI documented the development of 125 FAPUs with 112 occurring in the sacrum/ischium. A preliminary economic analysis of FAPUs documented approximately (US) $224,500 in preventable costs. Economic analysis of HCWI revealed approximately (US) $694,285 attributed to injury associated with patient repositioning. A quality improvement (QI) initiative was designed to improve patient safety and prevent HCWI.
Strategy and Implementation:
A QI implementation plan was developed collaboratively with the clinical staff to develop shared goals and objectives for improving patient safety and preventing HCWI associated with patient repositioning. The QI implementation plan included methods for educating staff on adhering to best practices in patient repositioning and methods for tracking compliance with QI interventions. A repositioning device was introduced to staff for use in a turning and positioning protocol to reduce turning time, increase patient comfort, and increase staff compliance with patient repositioning. Monthly progress reports were provided to staff to communicate progress and improvements in patient outcomes and prevention of HCWI. Continuous QI efforts included ongoing communication and review of patient outcomes, HCWI, and staff compliance.
Evaluation:
A before-after comparison demonstrated a 92% reduction in FAPU, 83% reduction in HCWI, and an 86% average compliance rate with QI efforts 15 months after the program implementation. The return on investment was calculated by assigning a cost of 8,730 per sacral/ischial FAPU and 22,500 per HCWI based on evidence-based figures.
Implications for Practice:
Collaboration with the healthcare team encouraged unit "buy-in" with QI interventions. Utilization of a repositioning device encouraged staff to adhere to best practices in repositioning due to ease of use and increased patient comfort. The QI protocol resulted in decreased FAPU and HCWI.