Nursing-sensitive quality indicators are those indicators that capture care or its outcomes most affected by nursing care.  Pressure ulcers are one of the ten identified nursing-sensitive quality indicators for acute care settings.  UWHC Nursing had for several years completed a quarterly pressure ulcer prevalence and incidence study.  This study was done by examining the skin of each patient in the hospital on the study day.  Results were shared with the units, as well as submitted to the National Database for Nursing Quality Indicators (NDNQI).  The sharing of results with the units allowed each unit to see how they were doing and to make improvements if needed.  The submission of data to NDNQI allowed each unit to have a benchmark against which to compare their results.  Units are compared in NDNQI to other units and institutions with similar patient populations.  While this quarterly study allowed us to have a snapshot of our overall performance, it was only four times a year.  In January 2005, we started a monthly pressure ulcer prevalence and incidence study.  This has allowed us to have more data, be more timely in giving feedback, and to keep a strong focus on our prevention and care of patients with pressure ulcers. 

At the University of Wisconsin Hospital and Clinics, our pressure ulcer prevalence and incidence rates have been within benchmarks.  As you can see from the graphic below, there is a downward trend in our incidence of pressure ulcers.  Each month a summary report is provided to each unit approximately one week after the study is completed.  The summary identifies those units that are beneath the benchmark, as well as those that are above the benchmark.  Those that are above the benchmark are asked to follow-up and provide a plan for performance improvement.  The information is also reviewed at the Nursing Quality Council and opportunities for performance improvement, education or necessary practice changes are discussed.   We’ve found that the impact of monthly monitoring along with rapid turn-around of reporting directly to staff and managers has been key to improving pressure ulcer incidence.