Eliminating Pressure Ulcers at Ascension Health

Purpose:
St.Vincents in Jacksonville,Fl was chosen as an Ascension Health 'alpha site' for the development of practices to eliminate facility acquired pressure ulcers. The initiative included the creation of the 'SKIN Bundle'(Surfaces, Keep patients moving, Incontinence management,Nutrition & Hydration)

Significance:
The W.O.C.N. Society estimates that more than 1 million persons in the United States develop pressure ulcers every year with incidence estimates ranging from .4% to 38% for patients in acute care facilities. Approximately 50% of these pressure ulcers will develop during hospitalization.

Strategy and Implementation:
The strategy to eliminate preventable pressure ulcers began with an expert meeting of WOCN's, educators, Nursing leadership, pharmacists, dieticians and P.I. to develop a 'best practice' prevention model.Literature and patient chart reviews were conducted to determine patients at highest risk for pressure ulcer development. Equipment and product reviews were conducted concurrently.Nutrional standing orders were approved by the Medical Executive Committee.Once the prevention model was completed, a standard of care was written and the SKIN Bundle was developed.Education consisted of brief presentations, posters, assessment pocket tools, just in time training at the bedside.SKIN champions were selected for each of the units.A timeline was developed for rollout to all units, then spread throughout Ascension Health at a Nursing summit. A weekly 'SKIN' operations meeting consisting of Executive and Unit based leadership reviews any hospital acquired pressure related injury weekly.

Evaluation:
Quarterly prevalence and annual incidence of pressure ulcers decreased from 5.7% to less than 1% from 12/2004 through 2/2006 and remains less than 1% to date. No Stage 3or4 injuries occurred between August 2004 and February 2006. No Stage IV's since 2004.

Implications for Practice:
The pride of practice in a nursing driven, successful innovation and the resulting staff empowerment influenced a profound culture change. Nursing leadership has maintained this culture change through the use of weekly operations meetings that now include review of all nursing driven outcomes.