Solving the Puzzle Pieces: A Facility Commitment to Reduce Hospital Acquired Pressure Ulcers

Purpose:
In 2009, the organization's Hospital Acquired Pressure Ulcer (HAPU) rates were trending upward. Comparison to NDNQI revealed opportunities, particularly in critical care. Internal investigation revealed inconsistent wound recognition and prevention. The goal was to reduce HAPU and improve care.

Significance:
Pressure ulcers are a significant health problem that increase patient suffering and impose financial burdens. They are complex clinically with multifaceted etiologies. As a nurse sensitive indicator, pressure ulcers are key measures that reflect the standard and effectiveness of care.

Strategy and Implementation:
The quarterly survey was redesigned as a team meeting where members received education, shared success stories and discussed opportunities. Findings were communicated to home units and graphs comparing to NDNQI were posted. The wound care nurses confirmed inter-rater reliability assessment and provided immediate feedback regarding wounds identified during the survey. Staffs from dietary, respiratory therapy and physical therapy were added to the survey team to offer a multidisciplinary approach. Hospital wide education was developed to help staff accurately identify and stage ulcers. Action based competencies using Braden scenarios facilitated identification of patients at risk and application of prevention strategies. A Pressure Ulcer order set was designed to assist in wound identification and empower nurses to apply treatments. Unit level projects emerged including turn teams for high risk units, monthly performance checks in critical care areas and population specific education.

Evaluation:
After implementing strategies, overall HAPU prevalence reduced from 2.9% in 2009 to 1.4% in 2010. Critical care units have maintained HAPU scores below the NDNQI mean for 3 consecutive quarters. Nutritional supplement compliance rates also improved. The project promoted peer accountability.

Implications for Practice:
Using various best practices such as staff empowerment, hospital wide education and multidisciplinary involvement propelled the quality improvements. Population specific projects helped sustain results. Timely, accurate identification of wounds allowed for early intervention and prevention.