Composing a collaborative symphony to decrease HAPU

Purpose:
To decrease the incidence of hospital acquired pressure ulcers by improving early detection measures of at risk populations and changing the rhythm of clinical practice to improve outcomes utilizing a multidisciplinary approach.

Significance:
HAPU are becoming a burden on health care. 2.5 million patients are treated for complications of pressure ulcers that increase mortality rates and carry a cost of 11 billion dollars. Policies lead by CMS and The Joint Commission are bringing the focus to cost effective prevention initiatives.

Strategy and Implementation:
The Opus of Change: Overture: A multidisciplinary team was assembled to attack HAPU increase in the acute care setting. First Movement: A PUP is born: The group, called the “PUP” team, made a mascot of a bulldog puppy named Braden. They identified areas that needed improvement while evaluating the IHI Bundle of Care. Goals were to improve the process of identifying patients at risk, to develop evidence based protocols, to educate direct care staff, to improve communication and to develop education materials for patients and families. Second Movement: Proactive not Reactive: Concurrent, not retrospective, chart review done to collect a baseline of data. Tracking system initiated to follow PU incidence. IT department added alerts based on demographic information. Dieticians stressed relationships between low pre-albumins and risk. Revisions made to assessment tools, protocols initiated to increase vigilance. Finale: All disciplines working in harmony to improve outcomes.

Evaluation:
A Review of the Piece: Collected data submitted to NDNQI to compare to national benchmarks. A decrease seen in PU incidence, limited HAPU complications, improved nursing quality and patient satisfaction, reduced associated costs of complications.

Implications for Practice:
The beat goes on: Nurses are the maestros that conduct the “HAPU Serenade”. NDNQI participation and PU prevalence studies made them virtuosos that continually review the process, identify failures and weaknesses and course correct in real time, giving way to a crescendo of improved patient care.