Reducing the incidence of pressure ulcers in nursing home residents: a prospective 6-year evaluation.

Despite numerous clinical efforts and regulatory mandates to reduce occurrence, pressure ulcers (PUs) continue to plague up to one fourth of patients in healthcare facilities. In 2003, staff and administrators of a 151-bed skilled nursing facility in the Midwest started a quality improvement project based on 1992 Agency for Health Care Policy and Research guidelines to reduce the incidence of facility-acquired PUs. Pre-initiative PU data collection suggested a 12% to 25% PU prevalence rate with an average pre-initiative incidence of 5.19% (168 acquired ulcers over 3,234 person-months). During the next 4 years post-initiative, the average incidence was 0.73% (47 acquired ulcers over 6,446 person-months). Implementation of the comprehensive preventive efforts involving an interdisciplinary team with strong leadership, intensive training, use of evidence-based protocols, carefully evaluated support surfaces and wound/skin products, and simplification of processes led to a significant (P <0.0001) and sustained reduction in the incidence and prevalence of PUs. Additional observations included a simultaneous and unexplained reduction in resident falls and an overall cost reduction of more than $124,000 per year. These results confirm that nosocomial pressure ulcers can be significantly reduced in long-term care when well-established standard guidelines are followed.