Driving change from the bedside-A staff nurse initiative to reduce hospital acquired pressure ulcers

Purpose:
At Hudson Valley Hospital Center we embarked on a journey to decrease our hospital acquired pressure ulcer rate though multiple initiatives. Through the practice of hourly rounding our staff developed new processes, protocols, and a new model of care delivery known as Turning Rounds.

Significance:
In 2008 we discovered that our hospital acquired pressure ulcer rates were above the national benchmarks from NDNQI. This had serious implications for both quality of care and reimbursment. As an organization, we acknowledged that delivering quality care within current resources was a challenge.

Strategy and Implementation:
A number of evidenced-based initiatives were put in place to address the hospital acquired pressure ulcer data results. One innovative idea developed by the staff was a patient care delivery model identified as Turning Rounds. This concept was developed by two of our staff nurses on the night shift. Our nurses collaborated to re-design their work-flow to meet patient needs. All patients that scored 18 or lower on the Braden pressure ulcer risk assessment scale are included in a Turning Log. The goal of repositioning patients every two hours was operationalized during the hourly patient rounding initiative. The staff developed a strategy that involved a team of two, usually a nurse and a nursing assistant, assigned to turn all patients on the unit identified at risk for skin breakdown. The assignment rotates among staff so each staff person has two or less hourly assignments per shift. To ensure accountability, each ‘team” signs off on the log as the patient is turned.

Evaluation:
Staff engagement in problem solving, wise use of resources, and evidence-based practice protocols helped to decrease our hospital acquired pressure rate in 2008 from 22% to 3% in three months; and we have been able to sustain our success for more than one year thus far.

Implications for Practice:
The Turning Rounds model has been well received by our nursing staff. It has been adopted by the other patients units and different shifts. Feedback from staff continues to improve outcomes, as nursing leadership and bedside RNs work together to develop and evaluate evidence-based processes.