Strategies to Dramatically Reduce Hospital/Unit Acquired Pressure Ulcers

Purpose:
Effectively reduce the incidence of hospital/unit acquired pressure ulcers over a two-year period from 12.17 percent to 0.85 percent.

Significance:
Hospital/unit acquired pressure ulcers (HAPUs) can significantly complicate and increase a patient's length of stay in the hospital. HAPUs can also greatly impact hospital reimbursement and the overall cost of a hospital stay.

Strategy and Implementation:
In July of 2009 a multidisiplinary task force was created to reduce HAPUs at Northeast Baptist Hospital. Daily and weekly skin assessment forms were created, and were completed by nursing staff and submitted to the unit nursing director and Chief Nursing Officer for review. Monthly prevalence studies were conducted on every inpatient unit on every patient by the Quality Director, nursing directors, and staff nurses. A screening tool was created to screen for the presence of pressure ulcers upon admission via the Emergency Department or direct admissions to the hospital. Presence of a community acquired pressure ulcer or hospital/unit acquired pressure ulcer required a phone call to the physician, a wound care consult, photographs to be taken and placed in the medical record, and the entering of an occurrence report electronically. Customizable turning schedules, pressure ulcer order sets, new skin care products, and better quality mattresses were also implemented to reduce HAPUs.

Evaluation:
Hospital/unit acquired pressure ulcer incidence was reduced at Northeast Baptist Hospital from 12.17 percent in July of 2009, to 0.85 percent in May of 2011. Successful reduction of pressure ulcer incidence was measured via monthly pressure ulcer prevalence studies on every inpatient unit.

Implications for Practice:
Through the creation of a multidisciplinary task force with implementation of turning schedules, order sets, screening tools, skin assessment forms, prevalence studies, and use of improved skin care products and mattresses, hospitals can significantly and consistently reduce their HAPU rate.