S.T.A.R. Trek: The Journey to reduce HAPU...going where we have not gone before!

Purpose:
Quarterly NDNQI surveys indicated continued hospital acquired pressure ulcers (HAPU) despite efforts to educate nursing staff in prevention. A new approach creating direct care nurse skin advocates at the unit level was identified by the organization as a new method to reduce HAPU rates.

Significance:
The NDNQI quarterly surveys over the last two years indicated static HAPU rates in some adult critical care units and neonatal units of 11%-13%. These rates were not only unacceptable to the organization, but unacceptable to the nurses on these units and the patients and their families.

Strategy and Implementation:
A Skin Team Advocate and Resource (S.T.A.R.) Committee was created at the Departmental level comprised of a direct care nurse from each unit. These S.T.A.R. members were given training on skin care, pressure ulcer prevention and device managment and allowed off the unit to meet together monthly to discuss, and strategize ways of improving sking integrity. IN addition, the S.T.A.R.s were mentored on the unit by the wound and skin nurse specialists and empowered to become unit based staff nurse advocates for skin care. An aura of excitement was cultivated by the S.T.A.R.s in preparation for the quarterly NDNQI skin surveys and friendly competition between units to reduce HAPU rates to zero begun! After the skin surveys, those units with ZERO ulcers were recognized and rewarded on their units by a surprise visit from the CNO and CQO and the skin nurse experts for outstanding work. Tootsie rolls in a STAR shaped dish signifies a unit with ZERO ulcers and is now highly coveted.

Evaluation:
One year ofter implementation of the STAR team, the aggregate HAPU rate (Q 1 2011) is down to 4.3%, with zero heel ulcers and a 50% reduction in device related ulcers. More importantly the culture has changed where all nurse look forward to the skin survey and getting a "ZERO" HAPU score.

Implications for Practice:
Reduction of HAPU can only occur with engagement of direct care nurses. Empower them at the unit level as skin resources and advocates through mentorng and education. To sustain success, develop a system of rewards and recognize their successes at the organizational level.