Impact of Staff Engagement and Reduction of Pressure Ulcers

Purpose:
The purpose of this session is to describe the collaborative efforts betweeing Nursing Leadership and staff nurses that resulted in a significant decrease in unit acquired pressure ulcer (PU)rates in a Medical Intesnive Care Unit (MICU).

Significance:
More than 2.5 million PU occur in United States healthcare facilities costing an average of $11 billion each year. Pressure ulcer prevention remains a key nurse sensitive indicator and is subject to federal and regulatory agency scrutiny.

Strategy and Implementation:
Two key elements in the reduction of unit PU was the appointment of MICU nurses to the Pressure Ulcer Task Force (PUTF)and the initiation of a Unit Based Practice Council (UBPC). An action plan was presented to and approved by the UBPC. Staff completed the NDNQI PU training module. Implementation of hourly rounds includes early identification of at risk patients, turning schedules and alternate support surface. The PUTF nurses educate their peers with a wound care tip of the month on a variety topics. PU documentation is done in the electronic medical record and white boards in patient rooms allowing for real time comparison of current wound measurements with those from previous shifts. PU assessment is discussed during bedside hand-off. The effectiveness of these strategies is evaluated through monthly PU data collection by a MICU nurse and posted on the nursing units. When a unit acquired PU is identified the staff conducts a root-cause analysis and an action plan is developed.

Evaluation:
Since the inception of a UBPC and staff participating on the PUTF, the MICU has reduced their unit PU prevalence rate. Using the NDNQI Unit comparative data, in 2010 the MICU was above the 75th percentile. In 2011 rate dropped, placing the unit in the 25th percentile.

Implications for Practice:
Sustained quality improvement requires the participation and dedication of nurse leaders and engaged staff nurses who understand their role in PU prevention. The MICU staff have the autonomy to practice changes and the accountability to maintain these changes to enhance quality care.