Preventing pressure ulcers in Connecticut hospitals by using the plan-do-study-act model of quality improvement.
BACKGROUND
Seventeen hospitals and the Peer Review Organization of Connecticut (Qualidigm) attempted to increase early identification of high-risk patients and utilization of pressure ulcer preventive measures.


METHODS
A multihospital retrospective cohort study with medical record abstraction was used to obtain a total of 1,955 (baseline) and 891 (follow-up) patients aged 65 years and older discharged after treatment for pneumonia, cerebrovascular disease, or congestive heart failure with a length of stay > or = five days. During a nine-month period, the hospitals conducted four plan-do-study-act improvement cycles and shared their results in conference calls and group meetings.


RESULTS
Statistically significant increases were noted from baseline (1/1/96-12/31/96) to follow-up (10/1/97-3/31/98) in identification of high-risk patients, repositioning of bed-bound or chair-bound patients, nutritional consults in malnourished patients, and staging of acquired Stage II pressure ulcers. Daily skin assessments occurred at a high rate in both periods. There were no statistically significant changes in other processes of care, pressure ulcer incidence, or mortality.


CONCLUSIONS
Performance of four pressure ulcer prevention processes of care increased concurrently with a multifaceted improvement intervention.
Lyder
Courtney H
CH
University of Virginia School of Nursing, Charlottesville, Virginia, USA. Lyder@virginia.edu
Grady
Jackie
J
Mathur
Deepak
D
Petrillo
Marcia K
MK
Meehan
Thomas P
TP
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009096:Multi-Institutional Systems / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D003668:Pressure Ulcer / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D011366:Professional Review Organizations; D012189:Retrospective Studies; D017749:Total Quality Management / Q000379:methods*