Reduction of nosocomial pressure ulcers in patients with hip fractures: a quality improvement program.

Pressure ulcers (PUs) continue to be a distressing medical problem. The Nursing Quality Improvement Unit of Israel's Hadassah Mount Scopus Medical Center designed and implemented a quality improvement intervention program to reduce the incidence of nosocomial PUs. Assessing data, it was found that 46.7 percent of nosocomial PUs develop inpatients with hip fractures. Following the first audit of all patients with hip fractures, an intervention program was focused on the orthopedic ward and the recovery room. Intervention in the orthopedic ward included providing each patient with a visco-elastic mattress and a specially designed cushion for the elevation of the affected limb. In the recovery room, pressure-relieving practices were introduced. Following the implementation of the intervention program, the second audit revealed a reduction in the incidence of nosocomial PUs from 12.9 percent to 0 percent. Although patients with hip fractures are still at very high risk of developing nosocomial PUs, prevention is feasible.