Staff Engagement Achieves Zero Defect of Hospital Acquired Pressure Ulcers

Purpose:
The Wound Care Priority Team was established in 2005 in response to pressure ulcer rates. After implementation of an evidence-based program, the team implemented Wound Resource Nurses (WRNs)on each inpatient unit as a strategy to increase engagement of bedside nurses.

Significance:
Peer education and review support our professional practice and accountability of all nurse professionals to practice to their professional standards. WRNs communicate the vision and evidence-based strategies for attaining zero defect of HAPUs to their peers at the unit level.

Strategy and Implementation:
The Wound Care Priority Team recruited 26 Wound Resource Nurses (WRN) with representation from all inpatient units and the emergency room covering all three shifts. Training consisted of a four-hour didactic and a four-hour practicum with a Wound Care Center nurse. The WRN serves as a unit-based consultant to the bedside nurse as well as assesses staff competencies, participates in performance improvement activities and reviews wound care documentation. WRN and other bedside nurses participate in Hospital Acquired Pressure Ulcer Quarterly Prevalence and Incidence studies conducting document review on the following day along. Areas of focus are: determination of present on admission or hospital acquired, risk assessment, subscale intervention compliance, diaper prevalence and device issues. HAPU cases identified during the study are presented through the peer review process by a unit bedside nurses to identify barriers to care and opportunities for system improvements.

Evaluation:
Overall prevalence rates fourth quarter 2007 were 4.9% compared to first quarter 2009 were 2.1%. Zero HAPU cases were reported in second quarter 2009 study in 9 of 11 units (82%)--zero in critical care and medical units.

Implications for Practice:
The outcomes from implementation of the Wound Resource Nurse role as a component of our evidence based Wound and Skin policies and procedures demonstrates a successful and sustainable strategy for staff engagement and peer accountability for prevention of HAPUs.