Organizational Teamwork in Decreasing Hospital Acquired Pressure Ulcers

Purpose:
In response to elevating hospital acquired pressure ulcer NDNQI rates, the Cleveland Clinic Nursing implemented several initiatives to education the nurses on pressure ulcer prevention, interventions, and treatment in 2008 and continue throughout 2009.

Significance:
In today's health care settings, organizations need to be more diligent than ever in our efforts to prevent and treat pressure ulcers. By focusing initiatives on nursing education and pressure ulcer prevention strategies, Cleveland Clinic decreased hospital acquired pressure ulcer rates by 43%.

Strategy and Implementation:
Cleveland Clinic initiatives to decrease hospital acquired included strategies for education, leadership, standardization of policies and supplies for treatment. Educational strategies included restructuring skin care education for nursing and patient care nurse assistant orientation programs, mandatory education for current nurses, education at the bedside on pressure ulcer documentation, and a guest speaker nationally known for the treatment of patients with pressure ulcers. Educational initiatives were a collaborative effort between Clinical Educators, Clinical Nurse Specialists, Certified Skin Care Nurses, and Nursing Quality Coordinators. Leadership strategies focused on accountability and monitoring patient outcomes. Standardization of policies, protocols, specialty beds, treatment supplies, and documentation provided a better understand for the nurse in caring for patients with pressure ulcers and preventing develop of pressure ulcers.

Evaluation:
Daily rounds on patients with pressure ulcers, weekly skin care prevalences, and monitoring documentation were the focuses for evaluation. Pressure ulcer prevalence rates decreased, documentation compliance increased, and several unit outperformed NDNQI benchmarks for organizations >500 beds.

Implications for Practice:
Decreasing hospital acquired pressure ulcers is a collaborative team effort. Continuous education and monitoring of treatments and trends in patient care are vital to sustaining strategies toward preventing hospital acquired conditions. Pressure Ulcer Prediction Models need further investigation.