Pressure ulcers are painful sores for wheelchair-bound or bed-ridden patients, and Beatrice Community Hospital and Health Center nurses and staff are on a mission to reduce or eliminate that pain by preventing the sores from occurring in the first place.

BCHHC concluded its formal participation in the Rural Nebraska Pressure Ulcer Prevention Collaborative this summer, and now hospital nurses and staff want to take their newly acquired education and passion for patient care beyond the hospital and into the community.

The overall goal of the collaborative was to reduce the incidence of pressure ulcers that develop in patients in rural healthcare settings -- specifically within hospitals and nursing homes -- by focusing on the prevention of pressure ulcers.

As a result of the collaborative process, participating hospitals and nursing homes are experiencing improvement in pressure ulcer reduction.  The percent of hospital-acquired pressure ulcers decreased from 35 percent to 12 percent from November 2009 through March 2010. The number of pressure ulcers in participating nursing homes decreased 64 percent during the collaborative period.

While Beatrice Community Hospital and Health Center started and completed the program with no hospital-acquired pressure ulcers, there is always more to learn and processes to improve upon, according to Jan Rains, a registered nurse and project coordinator for this performance improvement project at BCHHC.

"It was a neat experience to have the opportunity to learn from experts around the country and to collaborate with other hospitals that have successes and to work with them to improve our processes," Rains said. "Sometimes it’s the little changes that can make a big difference."

BCHHC used a multidisciplinary team of bedside nurses, dietitians, rehabilitative therapists and others to review and improve its pressure ulcer prevention program of care. Rains said among the process changes nurses made was to assess patients when they are first admitted to the hospital and to screen at-risk patients on a daily basis.

Rains said the next step is to share information with assisted living facilities and nursing homes and to build a community program that provides for continuity of care for all patients once they leave the hospital.

The Rural Nebraska Pressure Ulcer Prevention Collaborative began September 2009 with 24 hospitals participating and ended with an Outcomes Congress in June in which participants celebrated their successes and lessons learned.

"This initiative is a stepping stone for patient safety and helps lay the groundwork for communities to work together to ensure a smooth transition from one level of care to another in the area of pressure ulcer prevention," said Greg Schieke, senior vice president of CIMRO of Nebraska. CIMRO of Nebraska is the Medicare Quality Improvement Organization for the state of Nebraska.

The Centers for Medicare and Medicaid Services administers the QIO program across the country. Under contract with CMS, CIMRO of Nebraska works to promote quality healthcare services, determine medical necessity of services rendered and ensure professionally recognized standards of care are met for services rendered.