Impact of practice guidelines on support surface selection, incidence of pressure ulcers, and fiscal dollars

Predicated on a need to control overall hospital costs and to integrate a Level 1 trauma center (Campus A) with a family practice based tertiary care hospital system (Campus B), expenditures associated with rental support surfaces were evaluated. Consistency and appropriateness of support surface selection is necessary to promote positive clinical outcomes, patient comfort, and a healthier bottom line, despite increasing costs. Clinical practice guidelines for therapeutic support surfaces were developed to decrease support surface expenditures and maintain prevalence rates below national averages. Utilizing the Agency for Health Care Policy and Research algorithm for managing tissue loads, along with other guidelines, criteria for prevention, comfort, and treatment were developed to assist nurses and physicians in support surface selections. A prevalence study was conducted before these criteria were implemented and repeated 1 year later. Expenditures for all rental support surfaces were assessed quarterly. Campus A, with a history of higher financial expenditures, was monitored weekly to assess whether support surfaces selections met guideline recommendations. Nursing staff reviewed hospital protocol regarding guidelines before implementation, and a self-administered review test was required during the first year post-implementation. One year later, a modest decrease in annual expenditures for rental support surfaces was noted. Campus A had a decrease in nosocomial pressure ulcers, while Campus B had an increased prevalence rate. Staff selection of support surfaces, within guideline recommendations, improved to 75% on medical/surgical units, and 98.8% in ICUs on Campus A. Although implementing support surface selection guidelines did not result in a significant reduction in cost, it created a framework for monitoring future related decisions.