A Skin Champions Team: The Keys to a Successful Pressure Ulcer Prevention Program

Purpose:
NDNQI monthly prevalence and incidence surveillance studies revealed a steady increase in the number of hospital acquired pressure ulcers (HAPU). The goal was to decrease the number of HAPUs and create an effective and sustainable pressure ulcer prevention program.

Significance:
Hospital acquired pressure ulcers can place patients at risk for severe complications. They can also cause a significant economic impact on a facility. Current evidence indicates a team approach to pressure ulcer prevention decreases rates of HAPU.

Strategy and Implementation:
Using the PDSA Model of Performance Improvement, bedside nurses took ownership of improving patient outcomes through an aggressive Pressure Ulcer Prevention Initiative that included a multidisciplinary Skin Champions Team. The team created an action plan and conducted literature reviews. They implemented changes in interventions using evidence based practices. On admission, two nurses performed skin assessments to identify potential breakdown. Nurse generated nutrition consults were implemented as well as the ability to order pre-albumins. An aggressive turning program was instituted and pressure redistribution surfaces were upgraded. Dressings and other products were standardized throughout the facility and units were provided with skin care supply carts. All nurses completed the NDNQI Pressure Ulcer Training Modules. The team educated staff, patients and family members, as well as the community. Monthly “Skin Champions” and “Unit Champions” were identified and acknowledged.

Evaluation:
The data shows a dramatic decrease in the number of pressure ulcer incidence since the inception of the Skin Champions Team, as evidenced by the monthly prevalence and incidence data gathered for NDNQI. HAPU rates have remained at 0 for 6 consecutive quarters.

Implications for Practice:
A Skin Champions Team, driven by bedside nurses and utilizing evidence based practices, can decrease the rate of hospital acquired pressure ulcers, thereby improving patient care and safety. The team should be multidisciplinary, include a physician champion and have support from leadership.