When back to basics is not enough: Strategies to decrease HAPUs

Purpose:
In our hospital, the hospital acquired pressure ulcer (HAPU) rate was consistently above national benchmarks. A HAPU is a "never event" and should be preventable with appropriate nursing interventions. Our highest incidence of HAPUs occurred in our ICUs and it was essential for us to intervene.

Significance:
On-going emphasis on "back to basics" with attention to Braden Score assessment,targeted interventions, prevalence and incidence studies was not enough to effect change. Traditional strategies were not adequate and we sought additional measures.

Strategy and Implementation:
We evaluated the impact of new technologies on HAPUs in our critical care areas, conducting a controlled quality improvement study. Many of our patients are incontinent, and we found that standard methods of cleaning patients were actually contributing to breakdown, a precursor to pressure ulcer development. We evaluated the impact of a one-step cleanser/barrier product on incontinence associated dermatitis and compared HAPU rates pre and post implementation. We also noted that nursing time to turn critically ill patients was significant and could require up to four staff members to accomplish this, impacting the frequency of turning. We evaluated the impact of a turning and repositioning device to facilitate turning, finding this both efficient for time management and effective in off-loading the sacrum, essential for preventing HAPUs.

Evaluation:
We evaluated these innovations in ICUs and saw a decrease in incontinence associated dermatitis and HAPU rates where the cleanser/barrier products were implemented. With use of the turning and repositioning device, coupled with the cleanser/barrier wipes, the HAPU rate declined from 28% to 0%.

Implications for Practice:
Skin care and positioning are time honored interventions to prevent HAPU but poor patient outcomes led us to evaluate practice. Through exploring, evaluating and integrating new technologies into our arsenal of HAPU prevention, we moved to a new basic for care and improved quality.