The New Five Ps: Process, Partnerships, and Passion for Pressure ulcer Prevention

Purpose:
Although pressure ulcers are viewed as a nursing issue, other professionals influence their development and prevention. Often care efforts are not coordinated among involved providers. To address this, multidisciplinary stakeholders used evidence to shift the focus from treatment to prevention.

Significance:
Patient suffering and organization financial performance are two of many consequences of pressure ulcers. Despite considerable time and effort invested in developing evidenced-based prevention strategies, hospital acquired pressure ulcers have remained at about 7% nationally for the past 20 years.

Strategy and Implementation:
Preventing pressure ulcers is multifaceted and complex. In recognition of this a highly engaged team of 45 stakeholders representing various professions, organizational positions and levels, and vendor partners examined the prevention evidence. The goals were to decrease variation and standardize prevention practices across five system hospitals and to articulate each provider group's responsibilities in attaining zero hospital acquired pressure ulcers. The team used an integrative approach, combining the findings from research and expert practice to develop a pressure ulcer prevention bundle, that is, a collection of several scientifically grounded elements needed to effectively deliver care and improve outcomes for a particular issue. The team operationally defined the elements, which allowed for clarity related to care processes and product and technology use, ensuring consistency in bundle application. A scenario based educational program was created to support implementation.

Evaluation:
Process and outcome measures were used. Hospital acquired pressure ulcer rates have decreased by 30% system-wide, and many units are chasing zero. Staff feedback from pilot areas helped refine the bundle prior to full system rollout. Weekly unit audits show widespread implementation of the bundle.

Implications for Practice:
Engaging the wide array of partners who influence a care process early in improvement efforts and maintaining their involvement allows for broader thinking, increases the likelihood of successful change implementation, and contributes positively to the relationship building needed to sustain.