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To target problematic pressure ulcer (PrU) prevention factors identified following an increase in hospital acquired pressure ulcers (HAPU). The goal was to decrease HAPU events through consistent use of focused PrU prevention strategies across the continuum of care.
Significance:
Skin integrity management is a hallmark of quality nursing practice helping to achieve optimal patient outcomes. Our goal is "no events" of HAPU regardless of PrU stage. This project reveals the quick action taken by our multi-disciplinary team to reverse an unexpected increase in HAPUs.
Strategy and Implementation:
Six-Sigma's DMAIC (Define, Measure, Analyze, Improve, Control) methodology guided the multi-disciplinary team. Analysis identified inconsistencies in implementation of multiple evidence-based PrU prevention strategies during 2009. Improvement centered on assessing and prioritizing strategies with focused, consistent implementation of the high-prioritized items. Priority was placed on skin inspection for all admitted high risk patients through the emergency department; standardized photographic documentation assuring nurse-physician consensus; improved communication during shift change "huddles" and bedside report; and most importantly daily rounding by clinical specialists emphasizing PrU prevention. Additionally, a mystery shopper/reward program was initiated to reinforce turning schedules facility-wide and a daily PrU prevention monitoring board tracking days without a HAPU was implemented in the ICU.
Evaluation:
We will compare HAPU incidence and PrU prevalence for the ICU and Medical Units that demonstrated the unexpected spike in occurrence with pre and post-improvement data (2009 to 2010). Anticipated decline in HAPU incidence and prevalence will demonstrate effectiveness of the improvement program.
Implications for Practice:
Advanced technologies simultaneously created additional obstacles to PrU prevention. Multiple resources implemented concurrently created barriers to success. Focusing on a few evidence-based practices and doing them well, was more effective towards achieving our goal.