A Successful Pressure Ulcer Prevention & Treatment Program Implemented by a Med/Surg CNS and other Nursing Staff

Purpose:
Share successful, evidence-based strategies in the development of a pressure ulcer prevention and treatment program that positively impacts patients at the bedside.

Significance:
A Magnet facility reduced their hospital acquired pressure ulcer rate from 19% to 1.4% over 48 months. This is a very important nursing quality indicator for hospitals and ties directly with many regulatory requirements; one such requirement is the CMS "no pay" measure for pressure ulcers.

Strategy and Implementation:
Successful strategies implemented by a CNS and nursing staff include soliciting Executive and Management support to ensure pressure ulcer prevention and treatment is a priority for the facility and resources are allocated annually for this initiative. Secondly, a monthly Skin Care Resource Nurse meeting is facilitated by the staff, using evidenced based practice, to a group of over 30 nurses representing every acute care unit in the facility. Thirdly, under the supervision of the CNS, certified wound care nurses monitor the clinical units daily with a focus on prevention and treatment for Stage 2 and greater PUs. Fourth, managing the specialty support surfaces is important in the prevention and treatment of PUs that has clearly demonstrated a cost savings to the facility. And lastly, streamlined the quarterly prevalence studies to monthly studies to provide staff and management more timely feedback for corrective action.

Evaluation:
Stage 1 HA PU's decreased from 12% to 0% and Stage 2 and greater PU's decreased from 7% to 1.4%. As of Oct. 1, 2008, the facility has not had any stage 3 and 4 pressure ulcers. Demonstrated cost savings in specialty support surfaces has resulted in $40K in first quarter 2010 alone.

Implications for Practice:
Although the facility has had great success in reducing the pressure ulcer rate, the goal is 0% - to do no harm to patients. Within the past four years, the culture and standards have changed because nursing staff are taking ownership for patient care with a motto of, "not on my watch."