Walking Away from Pressure Ulcers

Purpose:
The Acute Care for Elders (ACE) Unit cares for acutely ill geriatric patients, 80% of whom are over 70 and many of whom have comorbidities. Recognizing that the risk of pressure ulcer development increases with age, the ACE Unit Council created an innovative prevention plan that improved outcomes.

Significance:
Nosocomial pressure ulcer development reflects the quality of nursing care, and prevention is especially important in the frail elderly. Additionally, pressure ulcer treatment can result in longer hospital stays and places additional strain on financial resources.

Strategy and Implementation:
With guidance from Advanced Practice Wound, Ostomy, Continence Nurses WOCN's)and input from the Skin Care Team (unit-based expert skin care nurses)and ACE Nursing Unit Council, a three-pronged strategy was developed. First, several traditional best practices were implemented: Braden Scale assessment on admission and daily; Skin Team monthly rounds and ongoing provision of staff education; and nurse-directed care that includes position changes every two hours, specialty mattresses, application of barrier creams and use of wipes. Next, “Wound Wednesdays” -- weekly direct care nurse assessment and documentation of skin condition for all patients – was instituted. Finally and most significantly, ACE Unit nursing practice evolved with the innovative “Step It Up a Notch” program. This twice daily walking program involves all patients with mobility challenges and their interdisciplinary caregivers.

Evaluation:
The ACE Unit 2006-2007 quarterly hospital acquired pressure ulcer rates exceeded the NDNQI database mean more than 50% of the time. Since “Step It Up a Notch” began in 2009, rates have been below the mean and the unit has had zero hospital acquired pressure ulcers in six of the past eight quarters.

Implications for Practice:
A grass roots ambulation initiative has improved geriatric patient mobility and tissue perfusion, resulting in sustained excellent outcomes. The prevention program includes comprehensive caregiver education, interdisciplinary collaboration, and direct care nurse initiation of interventions.