Rolling Against Pressure - 252 Days Injury Free

Hospital acquired pressure injuries continue to challenge our healthcare systems.  Since CMS removed additional reimbursement for conditions not present on admission, facilities have deployed many strategies in an attempt to decrease these conditions such as pressure injuries.  Rural hospitals with limited resources have to be creative to achieve acceptable outcomes.  Developing a no harm culture is essential, but can it be sustained or last the test of time?
Rural hospitals are plagued with limited resources and workforce shortages, amongst other barriers. Understanding these barriers or “pressures” while developing a new strategy was instrumental.
At NRMC our goal was to improve our hospital acquired injury rates, sustain consistency and continue a “No patient harm” culture.  As a team, we reviewed current best practice guidelines, developed a comprehensive plan, and concentrated on one pressure related risk factor that we can impact – early recognition & prompt interventions for patients being admitted or those that became malnourished after admission. 
It is estimated that 30 – 50% of patients being admitted to hospitals are malnourished.  At our hospital, 1 % of the patients that were admitted in 2015 had malnutrition as a primary or secondary diagnosis. According to statistics, these numbers indicate that patients with malnutrition may not be recognized promptly thus delaying treatment interventions.
Processes were developed for early recognition of malnutrition with prompt interventions to decrease hospital acquired problems such as pressure injuries.  We were able to achieve 252 hospital acquired pressure injury free days on all of our patients at our entire hospital followed by approximately 180, 213 and recently 313+ days.   Initially, our hospital skin injury acquired rate went from a yearly average of 1.87 to 0.12 injuries per 1000 patient care days.  In addition to improving our pressure injury program, our providers were able to appropriately diagnose/document malnutrition which lead to capturing proper reimbursement.
It was recognized that by announcing the number of pressure injury free days that it became a strong motivator.  Other industries utilize work injury free days as a way to motivate employees towards safe practices but also as a way for accountability and improving awareness.
 

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