Putting the Pressure on Reducing Hospital Acquired Pressure Ulcers

Purpose:
The Nursing Department monitors prevalence of hospital acquired pressure ulcers (HAPU) & benchmarks to NDNQI. In 2011, the hospital set a goal of reducing HAPU by 5%, focusing on accurate skin assessment & staging to improve inter-rater reliability & decreasing variance in how staging is specified.

Significance:
The assessment & identification of patients at risk for HAPU is an important component of patient management. HAPU prolongs the hospital stay, increases the risks of hospitalized acquired conditions, contributes to the seriousness of complications & increases patient discomfort.

Strategy and Implementation:
The Nursing Department revamped the PU Program; standardized care, education, & documentation across all campuses; comprehensive review of skin care products; algorithm for specialty bed use & approval; focus on skin assessment in ED and Periop; new beds, ED stretchers & OR positioning devices; review & validation of HAPU by wound, ostomy & continence care RN. A single day point prevalence study conducted monthly to measure pressure ulcers. Validation process resulted in re-staging of pressure ulcers & re-education on pressure ulcer staging & management. Focused monitoring of HAPU events allowed for improved trending over time and a reconciliation of HAPU. Education of 5000 staff members completed through self-learning on-line modules. Educational programs realigned & target staff, patients & families. Provision of adequate nutritional support in collaboration with the Food and Nutrition staff has proven to be successful in reducing HAPU occurrences & promotion of wound healing.

Evaluation:
As a result of these combined efforts, the Nursing Department met the 2011 goal of reducing HAPU by 5 percent compared to 2010. The Nursing Department has seen a 50% reduction in HAPU over the last 5 years: 2007-5.99%, 2008-4.07%, 2009-2.69%, 2010-2.48%, & 2011-2.39%.

Implications for Practice:
The hospital's goal is to sustain its HAPU rate reduction by introducing an early mobilization initiative: ambulating patients as soon as possible, especially in the intensive care units (ICU), which will further help reduce ICU HAPU. And implementing the Skin Resource Nurse Training Program