Implementing Evidence Based Practice at the Bedside to Eliminate Hospital Acquired Pressure Ulcers

Purpose:
Franciscan St.Francis experienced quarterly prevalence rates above the 50th percentile in cardiac critical care when compared nationally with NDNQI. In conjunction with NDNQI data, root cause analysis for all hospital acquired pressure ulcers (HAPU) was conducted to determine causative etiologies.

Significance:
Patients in acute care especially critical care are at increased risk for hospital acquired pressure ulcers. An estimated 2.5 million develop pressure ulcers yearly placing them in the top 3 death related errors. Treatment costs range from 2.2-3.6 billion with direct costs from 400,000-700,000/year.

Strategy and Implementation:
A skin management program, lead by a nurse driven clinical practice committee using 6 elements of prevention; policy updates, product standardization and algorithms was developed. Tying onto the skin management program, a team of subject matter experts convened to determine unique etiologies related to HAPU in cardiac critical care. A Clinical Nurse Specialist coordinated efforts and brought evidence to the bedside. Support from wound care manager was essential to determine best preventative therapies. Unit leadership and bedside staff were engaged and were instrumental in understanding the patient population, facilitating a comprehensive approach to decrease HAPU. Key components of the prevention plan consisted of: posting data on unit, monthly prevalence studies, “ultra-high” risk patients would not be positioned on their backs, patients expected to stay longer than 24 hours were placed on waffle mattress, and skin status was communicated during every nurse hand-off.

Evaluation:
Following implementation of the individualized pressure ulcer prevention plan in CCU, the unit has achieved seven consecutive quarters with zero hospital acquired pressure ulcers.

Implications for Practice:
Implementation of an evidence based skin management program was successful in decreasing HAPU prevalence. Additionally, engaging bedside nursing staff also supports the use of evidence based practice at the bedside and incorporates patient specific etiologies, thereby improving outcomes.