Reducing Tracheostomy-Related Hospital-Acquired Pressure Ulcers through a Bundle Approach

The prevention of hospital-acquired pressure ulcers (HAPUs) is a major focus for health care organizations. HAPUs are associated with increased costs and length of stay and considered a preventable condition by the Centers for Medicare & Medicaid Services. Tracheostomies and other medical devices are risk factors for developing HAPUs. At one medical center, the percentage of tracheostomy-related acquired pressure ulcers (TRAPUs) among adult tracheostomy surgery patients was 12.5 percent in fiscal year 2013 (July 2012 through June 2013) and 11.22 percent in fiscal year 2014 (July 2013 through June 2014).

An interprofessional process improvement team convened with the aim of reducing the percentage of TRAPUs in adult tracheostomy surgery patients to less than 5.88 percent by the end of fisc al year 2015 (June 30, 2015). A five-step TRAPU bundle was created to improve outcomes and then implemented in June 2014. Since the implementation of the TRAPU bundle, the medical center has seen a significant reduction in TRAPUs. At one point in fiscal year 2015, the percentage of TRAPUs in adult tracheostomy surgery patients was 1.41 percent.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine's six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/