• Crystal Lam, Adel Elkbuli, Brenda Benson, Elizabeth Young, Orlando Morejon, Dessy Boneva, Shaikh Hai, and Mark McKenney.
• Department of Surgery, Kendall Regional Medical Center, Miami, FL.
• J. Am. Coll. Surg. 2018 Jun 1; 226 (6): 1122-1127.

BackgroundThe development of hospital-acquired pressure ulcers (HAPUs) is a common complication associated with immobilization and prolonged hospitalization in trauma patients. Our semi-annual Trauma Quality Improvement Program report identified HAPUs as an outlier complication. We used a hospital-wide initiative to reduce the incidence of HAPUs among our trauma patient population. Our study aimed to determine whether the implemented measures would decrease HAPUs incidence rates.Study DesignWe reviewed adult trauma patients during a 3-year period. The novel care-based platform and preventive measures for reducing HAPUs included the following components: pressure-reducing beds; improved and protocolized nutritional support; mandatory 2-hour change of posture; turning clocks; early surgical intervention; spot checks by our wound care nurse; and education to patients and caregivers. Paired-sample t-test and chi-square analyses were used, with significance defined as p < 0.05.ResultsA total of 9,755 patients were admitted to our trauma services in the study period. Of these, HAPUs developed in 89 patients (mean age 57.9 years and 48 [54%] were female). The Injury Severity Score ranged from 1 to 75, with a mean of 20 in patients with HAPUs compared with 8 in patients without HAPUs during the same study period. The incidence of HAPUs at our institution was initially 1.36%, which decreased to 0.98% in year 2 and to 0.39% in year 3 (p = 0.002).ConclusionsThe novel 7-step care-based process changes, acquisition of specialized equipment, and educational initiatives implemented were associated with a significant decrease in the incidence rates of HAPUs.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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