Key Nursing Innovations that Drive Down Prevalence of Hospital Acquired Pressure Ulcers

Purpose:
Waterbury Hospital (WH) nurses were challenged to find a reliable, sustainable, evidenced-based approach to identify patients at risk for impaired skin integrity and to develop a plan to drive down the prevalence of hospital-acquired pressure ulcers.

Significance:
The precise application of software tools in concert with changes made to nursing practice have proven to be pivotal in the success of our hospital's skin care program. The project was completed in 3 months by nurses sharing a common purpose: to improve the care provided to our patients.

Strategy and Implementation:
This project was driven by nurses who participated on the Interdisciplinary Skin Care Committee. A subcommittee collaborated with the Clinical Informatics department to specifically focus on designing, building and implementing the technology enabled practice for the risk stratification, prevention, treatment and auditing of skin integrity concerns. This lecture will provide examples of three key nursing innovations that continues to drive the team's sustained success: 1.) identifying patients at risk for impaired skin integrity using a highly reliable, automated process; 2.) standardizing nurse-driven wound care protocols, displacing the traditional consult/paper order approach and 3.) implementing concurrent and retrospective computerized reports that use nursing data to identify patients with skin integrity issues.

Evaluation:
In October of 2007 WH's pressure ulcer prevalence rate was 7.4%. Six months after the implementation of the new computerized approach to skin care our rate was 1.4%. We continue to do quarterly prevalence studies, reporting to NDNQI. The average rate since the implementation of the changes is 2.3%.

Implications for Practice:
Direct involvement in this project has engendered a feeling of accomplishment in our nurses. Apart from the obvious, measurable improvements in quality of care, a lasting sense of pride and ownership of the program has germinated into a larger involvement in patient care intiatives on other fronts.