title: A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.
abstract: The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments.
  
  
  
  In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records.
  
  
  
  The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics.
  
  
  
  Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.
authors.affiliation: From the Clinical Services Group, Hospital Corporation of America (HCA), Nashville, Tennessee.
authors.forename: Jane
authors.initials: J
authors.lastname: Englebright
authors.forename: Ruth
authors.initials: R
authors.lastname: Westcott
authors.forename: Kathryn
authors.initials: K
authors.lastname: McManus
authors.forename: Kacie
authors.initials: K
authors.lastname: Kleja
authors.forename: Colleen
authors.initials: C
authors.lastname: Helm
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Korwek
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Perlin
mesh_terms: D006760:Hospitalization; D006764:Hospitals, Community / Q000592:standards* / Q000639:trends; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000639:trends*; D012307:Risk Factors; D012308:Risk Management / Q000379:methods* / Q000458:organization & administration; D014481:United States / Q000453:epidemiology