Combating Pressure Ulcers through Implementation of Unit Based Pressure Ulcer Prevention Protocol (PUPP) Teams

Purpose:
To share how one medical center decreased the incidence of HAPU through the development and implementation of an effective PUPP team at the unit based level.

Significance:
Pressure ulcers cause pain and suffering to patients, increased nursing hours for patient care, and increased cost of healthcare. The literature estimates that the cost of caring for patients with pressure ulcers can exceed $50,000 per incident depending on severity of wound.

Strategy and Implementation:
An 11% HAPU rate triggered intense chart review for inner-rater reliability and an educational needs assessment. Accurate Braden Scale scoring and knowledge of preventive strategies were identified as deficient. Skin resource nurses and PUPP Champions from each unit were recruited and trained to assist with PUPP education. Several strategies were implemented to support the PUPP Team Initiative. Development of an evidenced based pressure ulcer prevention protocol incorporated a standardized order set that alerted providers of high risk patients. The Interdisciplinary Wound Care Team created a Skin Risk Assessment Template which included the Braden Scale and patient specific interventions. Awareness increased significantly through the use of bedside posters, bi-weekly rounds with the Wound Ostomy & Continence Nurses and PUPP Champion communication with staff and families. These interventions have resulted in maintaining a HAPU rate below the national benchmark.

Evaluation:
Establishment of unit based PUPP teams significantly decreased the percentage of HAPUs from 11% to 2.5% over the past year.

Implications for Practice:
Education, engagement and empowerment of nursing staff can significantly improve nursing practice and outcomes related to the nursing sensitive indicator of hospital acquired pressure ulcers.