Sustaining Change in Hospital Acquired Pressure Ulcer Rate

Purpose:
The purpose of this presentation is to outline the interventions utilized to decrease the HAPU rate over a 2 year period. Additional literature review and interventions are outlined that illuminate the process of sustaining the positive change in hospital acquired pressure ulcer rate.

Significance:
This presentation is a significant contribution to nursing practice by presenting effective evidence-based interventions. Due to the length of data collection in a large urban hospital important insight is presenting into the need and methods of sustaining positive gains.

Strategy and Implementation:
Interventions over two years involved: skin assessment within the first 24 hours of admission; education on the completion of the NDNQI prevalence survey; WOCN to reconfirm the HAPU following the prevalence study; hourly patient rounds including skin assessment; 2 hourly turning with assigned turning buddies; weekly skin prevalence on units above the national benchmark; monthly skin prevalence on units below the national benchmark; use of pressure ulcer and incontinence skin care management protocol for Braden Score ≤ 18; dietary screening of patients admitted with pressure ulcers; and 4 types of moisture relief under-pads for patient use. The skin resource team consists of approximately 28 skin resource nurses, a PCT and RN from each unit. The team meets bi-monthly for an educational offering as well as quarterly for performance of the skin prevalence study. 25 representatives from the clinical practice council make up the skin committee that meets on a monthly basis.

Evaluation:
Over a two year course of evidence-based interventions, the HAPU rate dropped from 10.40% to 1%. However in the first two quarters of 2011 the HAPU rate inched up to 1.9% and 1.8%. A small increase in the rate signaled a need to sustain the gains made in the last two years.

Implications for Practice:
Sustaining change is routine practice of interventions. Practice is embedded in the system through policy and procedure and workflow. Adherence to interventions is achieved through a knowledge of rationale and available resources. Nursing leadership supports through performance evaluation.