Pressure ulcer prevention in hospitals is a critical issue since Centers for Medicare and Medicaid Services (CMS) established nonpayment policy for hospital‐acquired conditions in 2008. The objective was to determine the comparative effectiveness of quality improvement (QI) interventions for hospital‐acquired pressure ulcer prevention.
An interrupted time series quasi‐experimental design of pressure ulcer incidence correlated to QI adoption was the design of the study. Data collection was a survey of 55 academic medical centers of the University HealthSystem Consortium between 2007‐2012 characterizing adoption patterns of QI interventions for pressure ulcer prevention. Hospital‐level data pressure ulcer cases were analyzed (N=5,208). QI interventions were characterized according to the Nelson et al. best‐practice framework of 25 interventions and four domains: Leadership; Staff; Information Technology; and Performance & Improvement. Using effect size analysis, averages were calculated of quarterly changes in pressure ulcer incidence for QI interventions at each hospital. Across‐ and within‐hospital reduction significance was tested with t‐tests post‐CMS policy intervention.
Fifty‐three hospitals (96%) used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that reduced pressure ulcer incidence greater than 1 case per 1,000 patient admissions per quarter: Leadership Initiatives; Visual Tools; Pressure Ulcer Staging; Skin Care; and Patient Nutrition. The greatest reductions in incidence occurred earlier in the adoption process (p<0.05).
Five QI interventions had clinically meaningful effect on pressure ulcer prevention in academic hospitals. These QI interventions can be used in support of an evidence‐based prevention protocol for pressure ulcers. U.S. hospitals that are not in a position to conduct research on pressure ulcer prevention can utilize the findings of this study as a foundation for QI programs.
To cite this abstract:Padula W, Makic M, Mishra M, Campbell J, Nair K, Wald H, Valuck R. Comparative Effectiveness of Quality Improvement Interventions for Pressure Ulcer Prevention in Us Academic Medical Centers. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 127. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/comparative-effectiveness-of-quality-improvement-interventions-for-pressure-ulcer-prevention-in-us-academic-medical-centers/. Accessed April 7, 2020.