Zeroes are for Heroes: One Hospital's "Blueprint for Action" to Reduce & Prevent Pressure Ulcers

Purpose:
Our HAPU rate exceeded the NDNQI 90th percentile, indicating an urgent need to improve nursing clinical practice and patient outcomes. The goal was to improve organizational performance and reduce HAPU prevalence rate from 17.2% in 6/09 to 3.5% or less in 3/10 utilizing a rapid cycle PI initiative.

Significance:
Several of our patients had significant complications from HAPU, including multiple surgeries, invasive procedures, pain, as well as an overall reduction in their quality of life. Costs associated with these reportable events were significant and directly reflected nursing clinical practice issues.

Strategy and Implementation:
Despite active PI plans, the prevalence of HAPU had continued to increase. In response, a multifaceted “Blueprint for Action” was developed by the CNO and CWOCN that included unit based Skin Resource Nurses and a revitalized multidisciplinary wound team. A review of literature and best practices were conducted, leading to a full revision of the guidelines for wound care. Evidence based practice guidelines for pressure ulcer prevention and management were developed and integrated into day to day EMR documentation, MD order sets and treatment records. Pressure Ulcer Prevalence studies were increased from quarterly to monthly and conducted by the unit based Skin Resource Nurses. Revisions to skin care practices included changing the hospital formulary for approved skin products achieving the best in skin protection, healing and cost effectiveness. Skin care education was key; the CWOCN and Skin Resource Nurses are responsible to implement interventions, educate staff and lead by example.

Evaluation:
The "Blueprint for Action" was extremely successful; by 3/10 the HAPU rate was reduced to 2.8%, well exceeding our goal. Our current rate is 1.4%. Units were recognized through a “Zeroes are for Heroes” Campaign in which units achieving a 0% hospital acquired pressure ulcer rate are celebrated.

Implications for Practice:
A pressure ulcer prevention program founded on evidence based practice that is driven by bedside nurses, focuses on accountability, empowerment and recognition can decrease the rate of hospital acquired pressure ulcers, thereby improving patient outcomes.