Ownership & Accountability- The Key to Pressure Ulcer Reduction

Purpose:
The goal of our multipronged approach was to decrease hospital acquired pressure ulcer rates below the 8.3-8.6% prevalence rates that had persisted for three years.

Significance:
Pressure Ulcers, referred to as "never events" by the National Quality Forum, compromise patient progress, contribute to longer lengths of stay, increase hospital costs, and require increased nursing time and resources. Preventing pressure ulcers is within nursings' control.

Strategy and Implementation:
Despite employing well documented best practices that included forming a pressure ulcer committee, implementing risk assessment, reviewing product use, revamping our policy and documentation flow sheet, and educating nurses and nurses aides about prevention, our HA pressure ulcer rates remained static at 8.3%- 8.6% over a three year period. After regrouping our Pressure Ulcer Committee decided to focus on two strategies. The first involved setting specific and aggressive reduction goals by unit. For units above the NDNQI average, the goal was to be at or below the NDNQI average for the units' specialty group. For units who were at or bettter than the NDNQI average, the goal was to decreae rates by 25%. The superior target for everyone was 0%. The second strategy included driving data to the unit level via report cards, huddle communications and unit celebrations. These two strategies were championed by the Pressure Ulcer Committee whose membership came from units with high rates.

Evaluation:
After setting aggressive unit based targets and driving data relentlessly to the unit level, ownership and accountability shifted to the units and resulted in Pressure Ulcer prevalence rates that decreased from 8.3% to 5.2% in one years time after three successive years of no decline.

Implications for Practice:
Ownership & accountability create the momentum required for true culture change around practice at the unit level. Setting high expectations and keeping data alive foster this ownership and accountatbility. This strategy has implications for any practice change being implemented at the unit level