title: Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients.
abstract: BACKGROUND
  Under value-based purchasing, Medicare withholds reimbursements for hospital-acquired pressure ulcer occurrence and rewards hospitals that meet performance standards. With little evidence of a validated prevention process, nurse managers are challenged to find evidence-based interventions.
  
  
  OBJECTIVE
  The aim of this study was to reduce the unit-acquired pressure ulcer (UAPU) rate on targeted intensive care and step-down units by 15% using Lean Six Sigma (LSS) methodology.
  
  
  METHODS
  An interdisciplinary team designed a pilot program using LSS methodology to test 4 interventions: standardized documentation, equipment monitoring, patient out-of-bed-to-chair monitoring, and a rounding checklist.
  
  
  RESULTS
  During the pilot, the UAPU rate decreased from 4.4% to 2.8%, exceeding the goal of a 15% reduction. The rate remained below the goal through the program control phase at 2.9%, demonstrating a statistically significant reduction after intervention implementation.
  
  
  CONCLUSIONS
  The program significantly reduced UAPU rates in high-risk populations. LSS methodologies are a sustainable approach to reducing hospital-acquired conditions that should be broadly tested and implemented.
authors.affiliation: Author Affiliations: Wound Ostomy Continence Nurse Coordinator (Ms Donovan); Research Assistant (Ms Manta) and Research Associate (Ms Goldsack), Value Institute; and Director of Nursing Development and Education (Ms Collins), Christiana Care Health System, Newark, Delaware.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Donovan
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Manta
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Goldsack
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Collins
mesh_terms: D003422:Critical Care / Q000379:methods*; D003691:Delaware; D055318:Evidence-Based Nursing / Q000379:methods*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D015403:Nursing Evaluation Research; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000517:prevention & control*; D017592:Skin Care / Q000379:methods*