Utilizing Lean Methodology in Reduction of Hospital Acquired Pressure Ulcers (HAPUs)

Purpose:
Issue: Baylor Medical Center at Garland was above the NDNQI mean for hospital acquired pressure ulcers. Goal: Eliminate hospital acquired pressure ulcers at Baylor Medical Center at Garland.

Significance:
Hospital acquired pressure ulcers (HAPUs) are an avoidable injury that CMS regards as a never event. HAPUs can increase a patient's length of stay; decrease their quality of life and decrease patient satisfaction. HAPUs also impact a hospital financially by increased cost and reduced reimbursement.

Strategy and Implementation:
A multidisciplinary team was formed. Using Lean methodology the patient care process was researched and gaps in patient care that could result in a pressure ulcer were identified. Each area where a gap occurred that issue was evaluated and an evidence-based practice was identified to address the issue. The gaps were categorized in the areas of patient assessment, knowledge deficit, communication and teamwork, and patient safety. Solutions were identified for each category. A nursing unit was identified to trial the solutions. An educational program was developed that included PowerPoint slides with video messages from the Director of Acute Care Services and the team's physician champion. A role-playing skit was performed to demonstrate the new process. Subsequently the remaining nursing units received the educational program. A Skin Wound Assessment Team (SWAT) was formed with representatives from each nursing unit. SWAT members serve as their nursing unit's skin and wound expert.

Evaluation:
Success is measured by the NDNQI Pressure Ulcer Prevalence Study. The pilot unit that was averaging 3.52% with a mean of 2.45% has gone two quarters with a rate of O%.

Implications for Practice:
These changes in nursing practice result in improved patient care, safety and satisfaction, and increased cost savings to a healthcare institution. In addition, being below the NDNQI mean helps guide the Magnet journey.