Reducing Hospital Acquired Pressure Ulcers in the Critical Care

Purpose:
Based on NDNQI benchmark data, we were steadily climbing in the reported number of acquired pressure ulcers for our areas as reported in 2007. The Critical care service line includes 3 ICU's and four stepdown units. Our goal was to have Zero tolerance for Hospital acquired pressure ulcers (HAPU)

Significance:
The Institute for Healthcare Improvement set a goal:zero tolerance. HAPU can lead to 60,000deaths annually and is responsible for up to $11 billion in added treatment costs. Pressure ulcers also add up to &700,000 to the hospital's cost, and will result in payment denial by CMS as of Oct. 2008.

Strategy and Implementation:
A multidisciplinary team was formed Goals included reducing HAPU by a minimum of 50% with the ultimate goal of "zero" toelrance; adopt the IHI goal of "never event" for HAPU; improvement assessment skills and pressure ulcert identification; and improve compliance with appropriate interventions. In November, 2007, we implemented the following: a. Turning Schedule clock labeled "door" and "window" as opposed to right and left. b. Staff education c. Identified unit based "skin champions". d. Routine WOC rounding on units e. Reformatted the Skin Integrity CMG by risk category f. Updated patient education g. Piloted a Bowel Management System. The Staff Development Specialists in the units as well as the Skin Champions assisted with the required education to roll out these initiatives. Interventions were fully implemented in January, 2008.

Evaluation:
We celebrated a >50% improvement in unit acquired pressure ulcers as a service in April and May of 2008. NDNQI data reveals significant improvement in HAPU through the 1st quarter of 2009 for all units involved except 3D Pulmonary stepdown. We are very excited about this success!

Implications for Practice:
Practice implications include careful documentation about pressure ulcers, focusing on prevention of a pressure ulcer, and utilizing tools such as the turn clock for intervention. Individualized care plans are a must, and skin prevention is an ongoing team effort.