Head Down...Heels Up!

Purpose:
The incidence of hospital acquired pressure ulcers a concern to all nurses. In 2004 Emerson began conducting pressure ulcer prevalence studies and discovered an above average number of stage 1 pressure ulcers. As a result we embarked on an improvement journey to elimate all HAPU.

Significance:
Research has shown that patients who are at risk for developing pressure ulcers require comprehensive nursing assessments, interventions, and collaboration to minimize the development of hospital acquired ulcers. Decreasing the risk for these ulcers improves the patient's experience as a patient.

Strategy and Implementation:
When we discovered that we had a potential issue with skin integrity that could impact a patient's recovery and length of stay, the Skin Care/Ostomy Nurse developed a skin resource team of unit-based nurses interested in pressure ulcer prevention. In reviewing our data and the performance of our peer group we were able to zero in on several interventions that have been integral in improving and sustaining our performance. We developed a skin care module for our advanced patient care tech program. We implemented IHI prevention bundle strategies. We worked with our IT department to create prompts and improved assessment components to our documentation process. Our Skin Resource Nurse creates a detailed report at the end of each prevalence study that identifies patient characteristics and opportunities for unit based improvements. Our unit-based champions assist in developing algorythmns for skin care products and surfaces. NDNQI results are shared with nursing staff and leadership.

Evaluation:
Our success is measured by quarterly prevalence studies. Since 2008 we have sustained a zero rate in our critical care unit. Our medical surgical units are also doing very well. We have not had any hospital acquired pressure ulcers in the past 3 quarters. Previous studies showed small numbers.

Implications for Practice:
Our current success rates in preventing ulcers indicates a sustained practice change related to effective assessment and identification of patients at risk. Patient care techs report to nursing staff any signs of potential skin integrity problems. All staff remain aware of our role in prevention.