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Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients

Donovan, Elizabeth A. MSN, RN, CWOCN; Manta, Christine J. BS; Goldsack, Jennifer C. MChem, MA, MBA; Collins, Michelle L. MSN, APN, RN-BC, ACNS-BC

JONA: The Journal of Nursing Administration: January 2016 - Volume 46 - Issue 1 - p 43–48
doi: 10.1097/NNA.0000000000000291

BACKGROUND: Under value-based purchasing, Medicare withholds reimbursements for hospital-acquired pressure ulcer occurrence and rewards hospitals that meet performance standards. With little evidence of a validated prevention process, nurse managers are challenged to find evidence-based interventions.

OBJECTIVE: The aim of this study was to reduce the unit-acquired pressure ulcer (UAPU) rate on targeted intensive care and step-down units by 15% using Lean Six Sigma (LSS) methodology.

METHODS: An interdisciplinary team designed a pilot program using LSS methodology to test 4 interventions: standardized documentation, equipment monitoring, patient out-of-bed–to–chair monitoring, and a rounding checklist.

RESULTS: During the pilot, the UAPU rate decreased from 4.4% to 2.8%, exceeding the goal of a 15% reduction. The rate remained below the goal through the program control phase at 2.9%, demonstrating a statistically significant reduction after intervention implementation.

CONCLUSIONS: The program significantly reduced UAPU rates in high-risk populations. LSS methodologies are a sustainable approach to reducing hospital-acquired conditions that should be broadly tested and implemented.

Author Affiliations: Wound Ostomy Continence Nurse Coordinator (Ms Donovan); Research Assistant (Ms Manta) and Research Associate (Ms Goldsack), Value Institute; and Director of Nursing Development and Education (Ms Collins), Christiana Care Health System, Newark, Delaware.

The authors declare no conflicts of interest.

Correspondence: Ms Goldsack, Value Institute, Christiana Care Health System, 4755 Ogletown-Stanton Rd, Newark, DE 19718 (

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