Staff engagement: a key to pressure ulcer reduction at an acute care community hospital

Purpose:
To decrease the incidence of hospital acquired pressure ulcers to a rate of 0% at a community hospital through staff engagement, evidence based nursing interventions and restructure of the Performance Improvement Council.

Significance:
Hospital acquired pressure ulcers are avoidable injuries and incidence is now linked to reimbursement. Embracing a culture of quality nursing care directly impacts pressure ulcer incidence. The incidence of hospital acquired pressure ulcers at this facility in 2008 was 4.5%. The goal for 2009 is 0%.

Strategy and Implementation:
Strategies began several years ago to decrease the incidence of hospital acquired pressure ulcers. Strategies were generated from unit based councils, and the Performance Improvement Council. Innovative approaches using evidence based practice include unit based skin teams and champions, “second pair of eyes” for admission skin assessment, hourly rounding, new cleansing bath products, skin care products at the bedside, absorptive pads, heel pressure relief boots, disposable overlay air mattress and chair cushions. Careplanned interventions include daily skin risk assessment, pressure point assessment each shift, turns every 2hrs, heels elevated with pillow, daily outcome evaluation. In January 2009, a skin subcommittee was formed and led by a clinical nurse specialist to drive the improvement process.

Evaluation:
First and second quarter 2009 hospital acquired pressure ulcer rate decreased to 1.6%, a significant decrease from 2008. Success of these strategies was dependent on the motivation and engagement of bedside nurses and their commitment to improving patient outcomes.

Implications for Practice:
Engaging staff in patient improvement processes is crucial to the success for implementing evidence based practice changes. Unit based skin champions were instrumental in mentoring of peers and altering the culture with a focus on pressure ulcer prevention.