Taking the Pressure Off: Impacting the Rate of Hospital-Associated Pressure Ulcers

Purpose:
Issue: Persistent rate of 6% hospital-associated pressure ulcers (HAPU) over a two year period from 2006 - 2007. Goal: Provide a predictive risk assessment tool using the Braden scale and associated care plan as initial strategies to further reduce the HAPU rate.

Significance:
Pressure ulcer prevention is a priority quality measure. For patients, HAPUs increase length of stay, alter quality of life and correspond to a greater risk of infection. For hospitals, HAPUs have a significant financial impact, related, in particular, to changing CMS reimbursement policies.

Strategy and Implementation:
We implemented the Braden scale and PUP care plan through our shared decision making network in October 2007. The neuro unit's team assessed 3 predictive tools and chose the Braden. With wound care specialists, they adapted an evidence-based care plan. The team and a clinical educator developed training for RNs and CNAs that the team of direct-care staff delivered. This model was used throughout the house. We refined our PUP survey team to include inpatient & outpatient experts as team leaders and created the expectation of real-time teaching moments and rapid feedback to managers. We developed a Skin Care Team to perform weekly or biweekly skin audits and act as resources/unit experts. We collaborated with IS to develop a weekly Clarity report to catch patients discharged with a HAPU code. Skin care team members perform a "deep dive" to determine cause & learnings. We gather and disseminate significant data, including NDNQI and internal reports on specifics and trends.

Evaluation:
Combination of interventions has been highly effective. Our HAPU rate decreased to 3.52 in 2009, and was 2.75 & 0.89 respectively during Q1 & Q2 of 2010. The Skin Care Team has knowledgeable reps from each NDNQI-measured unit. We're using Clarity data for trending and basis for further impact.

Implications for Practice:
Use of Braden and PUP care plan guide assessment and interventions. Skin audits provide real-time feedback to managers and staff. Skin Care Team provides resource to unit staff. NDNQI and internal data guide efforts and determine trends for further improvement. Shared decision making is vital.