Getting there is good; staying there is better

Purpose:
This presentation describes an approach to pressure ulcer reduction that produced remarkable improvement, for 24 months, continuing today. The multidisciplinary team developed a pressure ulcer bundle that reduced prevalence rates by 60%. The project is now incorporated into the unit culture

Significance:
The agencies that judge fitness for reimbursement and accreditation focus on prevalence, and compliance with assessment, treatment, and documentation. The rules may have tightened, but nursing interventions remain the key in preventing and treating the complication identified as a ‘never' event.

Strategy and Implementation:
The 40-bed Surgical ICU of a 1400 bed Magnet hospital formed a quality improvement team to address escalating pressure ulcer rates. Thirteen most wanted improvements (MWI) were identified by a multidisciplinary team comprised of staff nurses, managers, a Clinical Nurse Specialist, Wound Care Specialist, Nursing Quality Coordinator, and an unlicensed patient care provider. The MWIs served as a bundle of interventions with individual merit that collectively created a synergy which fueled the project. Each MWI was assigned to team members and was budget- neutral in its solution. Included in the MWIs was a requirement for staff to complete NDNQI-sponsored Pressure Ulcer Training Modules. Nursing leadership was critical to the success of the improvements to care and the impressive outcomes. Resource allocation and cooperation across service lines formed the core of the team's success.

Evaluation:
Unit-Acquired Pressure Ulcer rates fell from 22% to 8% in a 12 week period. With a lowered NDNQI benchmark in 2010, the unit exceeded its original results and sustained the level of quality. The project is now incorporated into the unit culture and surpasses the 2011 NDNQI goals.

Implications for Practice:
The nurse-sensitive actions, which could be translated to any practice setting, emphasized cooperation across service lines putting aside turf and comfort zones, in the interest of improving the patient experience.