title: Ability, incentives, and management feedback: organizational change to reduce pressure ulcers in a nursing home.
abstract: OBJECTIVE
  Quality improvement (QI) processes in nursing homes are highly variable and often ineffective. This study evaluated an innovative QI process to reduce pressure ulcers (PUs) in a nursing home with a high rate of PUs.
  
  
  METHODS
  This was a 48-week, longitudinal study comparing the incidence of PUs during 12-week baseline and intervention and post-intervention periods.
  
  
  METHODS
  Not-for-profit, 136-bed nursing home in urban Western Pennsylvania.
  
  
  METHODS
  All residents and all staff at the nursing home participated in this study.
  
  
  METHODS
  The intervention consisted of 3 components: Ability enhancement, incentivization, and management feedback. To enhance ability, all staff members completed a computer-based interactive video education program on PU prevention and were mandated to use penlights to promote early detection. Incentivization included $75 for each staff member if the desired reduction in PU incidence was achieved. Management feedback provided real-time information of staff"s adherence to the mandated training.
  
  
  METHODS
  Outcome measures consisted of staff's adherence to mandated training and the incidence of new PUs during the baseline period compared to the intervention and post-intervention periods.
  
  
  RESULTS
  Management responded to noncompliance with training with both rewards and stepped discipline. Adherence to protocol, as measured by training compliance, was 100%. There was a significant reduction (P < .05) in the incidence of stage 2 or worse PUs during the intervention period. During the post-intervention periods, the effect was lost.
  
  
  CONCLUSIONS
  An innovative QI initiative resulted in a significant decrease in PUs in 1 facility. This intervention was not sustainable when the 3 components of the QI intervention were no longer actively maintained.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15241, USA. rosenji@upmc.edu
authors.forename: Jules
authors.initials: J
authors.lastname: Rosen
authors.forename: Vikas
authors.initials: V
authors.lastname: Mittal
authors.forename: Howard
authors.initials: H
authors.lastname: Degenholtz
authors.forename: Nick
authors.initials: N
authors.lastname: Castle
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: Shelley
authors.initials: S
authors.lastname: Hulland
authors.forename: David
authors.initials: D
authors.lastname: Nace
authors.forename: Fred
authors.initials: F
authors.lastname: Rubin
mesh_terms: D000368:Aged; D001076:Aptitude; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004647:Employee Discipline; D030141:Feedback, Psychological; D006282:Health Personnel / Q000193:education / Q000458:organization & administration / Q000523:psychology; D006801:Humans; D015994:Incidence; D007318:Inservice Training / Q000458:organization & administration*; D008137:Longitudinal Studies; D009042:Motivation; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D010559:Personnel Management / Q000379:methods*; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D015397:Program Evaluation; D017749:Total Quality Management / Q000458:organization & administration*