Setting: All inpatient areas were surveyed with the exception of pediatrics, maternal-child health, and the behavioral health unit. Median sample size was 326 patients/quarter.

Instruments: Data collection tool developed using the National Database of Nursing Quality Indicators (NDNQI), WOCN, and NPUAP guidelines.

Methods: Quarterly, a single day prevalence study was conducted in 2005 and 2006. Data was collected by two certified wound, ostomy, and continence nurses and a team of registered nurses who were trained in data collection and identification of pressure ulcers in accordance with the NPUAP and WOCN guidelines. Wound care clinician re-assessed all nosocomial pressure ulcers to test reliability of data for correct staging and documentation of ulcer. Data was analyzed and, the PDSA process was utilized to implement improvements. Information was disseminated to nursing units and action plans for improvement were developed.

Results: There was no significant difference in the age (mean-66), gender, or Braden score (mean-17) during the study. Overall prevalence in the first five quarters was 10.1%. Score for stage II pressure ulcer or above was 4.4%. In February of 2006 interventions were implemented. Overall Prevalence score post-implementation was 4.5%, an improvement of 55%. Score for stage II pressure ulcers or above was 2.9%, an improvement of 34%.

Conclusions: Using NDNQI data and process improvement can help to standardize pressure ulcer care as a quality indicator. Quarterly prevalence studies, in combination with, staff and patient education, development of goals, and communication of pertinent information at the unit level can have a positive impact on the quality of patient care by reducing the rate of nosocomial pressure ulcers.