Crescendo-Decrescendo: How the Rhythm of Pressure Ulcer Prevalence has Changed

Purpose:
To reduce hospital acquired pressure ulcer prevalence in a mid-sized, acute care hospital in New England.

Significance:
The hospital acquired pressure ulcer (HAPU) prevalence was much higher in our suburban acute care hospital than in NDNQI benchmark facilities. Additionally an external incentive to reduce prevalence was provided by a Massachusetts movement to publicly post HAPU prevalence rates on a consumer website

Strategy and Implementation:
An innovative program of education, awareness and information technology enhancements combined with development and empowerment of a team of ‘skin experts' (SWRG) was extremely effective in quickly reducing previously intractable HAPU prevalence hospital-wide. The team designed three mandatory learning modules for the staff to enhance their ability to identify pressure ulcers and distinguish them from ulcers of other etiologies. T-shirts with the “Year of the Skin” logo were designed and worn in a marketing campaign to raise awareness of skin issues. Additionally, whenever an educational event presented any skin content, the logo was prominently affixed to the notices. With the addition of active peer consultation on skin and wound issues at the bedside and the addition of electronic medical record custom screens that required documentation of the presence of pressure ulcers immediately upon admission, the prevalence of hospital acquired pressure ulcers plummeted within 2 months.

Evaluation:
HAPUs dropped precipitously from 14.8% to 2.3% within 3 months and has been sustained well below the NDNQI benchmark for over 2 years. Compliance with performing skin risk assessments and physical assessments within 24 hours of admission rose from 54% to 99% with technology enhancements.

Implications for Practice:
Widespread adoption of customized electronic medical records can strengthen documentation of skin integrity. HAPUs can be reduced and sustained with constant vigilance and reinvigoration of quality improvement projects that must involve the nurses providing direct care to patients at the bedside.