A NDNQI quality improvement project: Decreasing HAPU through nursing rounds

Purpose:
To develop a nursing educational program in the surgical ICU (SICU) to increase knowledge of pressure ulcer (PrU) prevention interventions. This quality improvement project evaluated the effectiveness of nursing bedside rounds (NBR) as a strategy to decrease hospital acquired pressure ulcers (HAPU).

Significance:
The HAPU rate in the SICU was unacceptably high and previous clinical interventions did not have a positive impact on patient outcomes. Developing an education program delivered peer to peer during patient care provided real time education to positively impact outcomes.

Strategy and Implementation:
Chart audits demonstrated the Braden® Score was completed, but it was unknown if the nurse had developed a dynamic plan of care derived from risk variables to prevent HAPU. NBR were created to connect documented strategies to patient care. Weekly, two lead SICU nurses and a WOCN conducted NBR asking bedside nurses information about their specific patient: current Braden Scale score, interventions related to subscale risk assessment, therapeutic surface use, pressure relieving devices, and moisture management strategies. If a PrU was present, the current treatment was re-evaluated for effectiveness. The importance of connecting the Braden Score to preemptive and active interventions was needed to reduce HAPU. Eventually, the lead SICU RNs independently completed NBR during their shifts. NDNQI PrU Prevalence Quarterly Reports were tracked to evaluate effectiveness of NBR. Prevalence reports were evaluated from 2008 - 2010.

Evaluation:
Prior to NBR the HAPU rate was 27% and after the rate trended down to 0% and sustained for three quarters. Prevention interventions also increased: use of prevention surfaces increased 92%, repositioning increased 30%, nutrition intervention increased 77%, and moisture management increased 100%.

Implications for Practice:
Implementing NBR was an effective strategy to increase bedside nurses' knowledge of the Braden Score, subscales, and accountability for HAPU prevention strategies based on assessment. The unit acquired PrU rate decreased despite the inherent high risk nature of this patient population.