Large-Scale Hospital Mattress Switch-Out
Leads to Reduction Hospital-Acquired
Pressure Ulcers: Operationalization of a
Multidisciplinary Task Force
Kerri Elsabrout, RN, DNP, FNP-BC, NEA-BC • Eleanor Orbacz, RN, MSN •
Leigh Anne McMahon, RN, MSN, MHA, NEA-BC • Susan Apold, PhD, ANP-BC,
Background: Identifying strategies to protect patients most at risk for hospital-acquired pressure
ulcers (HAPU) is essential. HAPUs have signiﬁcant impact on patients and their families and have
profound cost and reimbursement implications.
Aims: This article describes the successful implementation of a hospital-wide mattress switch-
out program using a Multidisciplinary Task Force, which resulted in a decrease in HAPUs and
signiﬁcant cost savings.
Results: As a result of this quality improvement project supported by evidence, the hospital
realized a 66.6% decrease in Stage III and IV HAPUs, a 50% reduction in patient complaints
about mattress comfort, a cost savings of $714,724, and an endorsement of bedside nurse
clinical autonomy by nursing and executive leaders.
Linking Evidence to Action: Nursing leaders can effectively realize large-scale initiatives by de-
veloping and implementing wide-ranging operational projects, like this 2.5-day, 275-bed hospital
Although clinical situations and populations can vary greatly
in hospitals nationally, the Centers for Medicare & Medicaid
Services (CMS) have deemed hospital-acquired pressure ulcers
(HAPUs) Stages III and IV as preventable for all inpatient facil-
ities (CMS, 2015). HAPUs are devastating to patients and their
recovery; nationally HAPUs are associated with patient morbid-
ity and signiﬁcant treatment costs are estimated at $11 billion
dollars annually (Health Research & Educational Trust, 2017).
CMS has required that hospitals report HAPU data since 2007,
and will not reimburse hospitals where the injury occurred for
the treatment of these HAPUs (Zaratkiewicz et al., 2010). This
can have signiﬁcant reimbursement implications for facilities.
Furthermore, the mandatory public reporting of HAPUs has
resulted in an increased national awareness of the incidence
of these complications, as well as interventions that aid in pre-
vention. However, reported data on hospital report cards does
not take into account inherent patient clinical characteristics,
acuity, or patient compliance, and may not necessarily portray
an accurate reﬂection of nursing care. Nonetheless, the pre-
vention, early treatment, and reporting of HAPUs require the
attention of hospital and nursing administration (Meddings,
Reichert, Hofer, & McMahon, 2013).
SYNTHESIS OF LITERATURE
An essential element of acute care nursing is assessment of the
risk of development of pressure ulcers, usually evaluated with
the Braden scale (Cooper, Vellodi, Stansby, & Avital, 2015). The
National Pressure Ulcer Advisory Panel (NPUAP) guidelines
recommend that a skin assessment be performed within 8 hr
of admission and every shift thereafter (Health Research &
Educational Trust, 2017; NPUAP, 2016).
There are several core nursing actions that help prevent HA-
PUs, speciﬁcally off-loading, frequent turning and positioning,
early mobilization, moisture control, nutrition optimization,
and alternating air pressure redistribution for high-risk pa-
tients (Health Research & Educational Trust, 2017; NPUAP,
European Pressure Ulcer Advisory Panel and Pan Paciﬁc Pres-
sure Injury Alliance, 2014; Swafford, Culpepper, & Dunn,
The use of bed mattresses for pressure ulcer preven-
tion is somewhat controversial in the published literature.
Bhattacharya and Mishra (2015) report that special mattresses
can relieve external pressure on susceptible body areas
(Bhattacharya & Mishra, 2015). However, the authors acknowl-
edge that formulating a clear conclusion about the effects of
support surfaces in pressure ulcer prevention is difﬁcult.
Worldviews on Evidence-Based Nursing, 2018; 15:3, 161–169.
2018 Sigma Theta Tau International