2 educational objectives

Objective 1.  Name two strategies used to improve hospital acquired pressure ulcers.

Objective 2.  Identify a reasonable amount of time it might take to improve hospital acquired pressure ulcer rates. 

  Purpose

The purpose of this presentation is to describe the specific interventions we implemented to improve the rate of hospital acquired pressure ulcers in our Intensive Care Unit (ICU).  Benchmark data from the National Database for Nursing Quality Indicators was instrumental in providing us with a goal to shoot for. 

  Description of how the session will provide relevant and current knowledge

In this session we will provide specific interventions we used in our ICU to decrease our hospital acquired pressure ulcer prevalence from twice that of the national average to below the national average.  An important point of our presentation that will be highlighted is length of time and the perseverance required to improve our rate of hospital acquired pressure ulcers.  

  Summary of presentation

Our ICU is a 44 bed unit, that provides trauma, neurological, neurosurgical, and medical/surgical services to a population of both urban and rural residents.  There are over 125 nurses used to staff the ICU.  The administrative structure of the unit includes one Nurse Manager, four Nursing Supervisors, a Clinical Nurse Specialist, and two Nursing Educators. 

In April of 2005 the rate of hospital acquired pressure ulcers in our Intensive Care Unit (ICU) was 38%, which was over twice the national average.  Over the course of one year's time we implemented several interventions to address this issue.  Interventions that were introduced included: (1) translating numeric data into meaningful information that bedside clinicians can interpret and understand, (2) shifting from a quarterly prevalence assessment to weekly assessments lead by a nursing supervisor, (3) re-structured the skin team made up of primarily staff nurses, facilitated by a nursing supervisor, (4) improved and re-structured documentation for risk assessment and prevention strategies, (5) implemented mandatory educational classes, (6) used Braden scores to drive skin care, including use of specialty mattresses, (7) created a computer database to track weekly prevalence rates and provide specific data elements about those with hospital acquired pressure ulcers, (8) enlisted the expertise of a Wound Ostomy Continence Nurse.  Importantly, it took over one year to “hard-wire” all of these interventions after which time we appreciated a reduction of hospital acquired pressure ulcers to below the national average.  Currently, the rate of hospital acquired pressure ulcers (measured at one week intervals) in our ICU is 13% and has remained at this level for over four months. 

  Implications for practice

While it took over a year for our ICU to improve the rate of hospital acquired pressure ulcers, our staff is engaged in and very motivated to maintain quality in our unit.  The term “nurse sensitive indicator” is now tangible and has been incorporated into our unit culture.  Having benchmark data was instrumental, and is now what we use to convey the standard of care expected in our unit.