Turning Evidence Based Research into Evidence Based Practice in Pressure Ulcer Prevention

Purpose:
Prevalence of unit acquired pressure ulcers continues to be an issue despite extensive evidence based research. The aim of this project is to effectively implement research into practice and decrease pressure ulcer prevalence in a high-risk patient population on a medical-surgical unit.

Significance:
Prevention of ulcers is an integral part of creating a healing environment. Patients on the unit are at high risk of breakdown with a mean Braden scale of 14.63 compared to 18 for the organization. Based on NDNQI data, the unit acquired PU rate was 3.58% in 2010 and included two stage III ulcers.

Strategy and Implementation:
The strategy of this project was to develop a culture change among staff in order to successfully implement prevention strategies. The use of nursing assistants as Team Leaders in collaboration with RN Wound Care Coordinators increased awareness and accountability while developing leadership skills on the unit. Team Leaders were inclusive of all shifts and these leaders were influential in creating ulcer prevention as a priority. A calendar documenting days without UAPUs was posted in the staff break room for increased awareness and recognition. Root cause analysis was used when development of any pressure ulcer occurred. Wound Care Coordinators on the unit, who are trained in NDNQI data collection and given additional education on pressure ulcers, increased rounding from monthly to weekly. Compliance to turning schedules and accurate intervention increased due to role modeling offered by coordinators and leaders and the influence of peers on the staff's priorities.

Evaluation:
The first two quarters of 2011 have zero prevalence of unit acquired pressure ulcers based on NDNQI data. With the first seven weeks of the initiative, a UAPU was found each week with an average prevalence of 10.22%. For 2011, the average prevalence is 1.29%, with 18 of 23 weeks at zero prevalence.

Implications for Practice:
Implication of this initiative requires multiple team leaders inclusive of all shifts. Rewards and recognition are used along with visible tracking of success and failure. Any breakdown in implementing the initiatives should be addressed as it takes the whole team to create successful prevention.