From Audit to Action: Reducing Hospital Acquired Pressure Ulcers

Purpose:
Use of a web based pressure ulcer audit, improved audit efficiency as it increased accessibility, decreased audit time, and resources needed. The hospital acquired pressure ulcer alert requires the WOCNs to concurrently validate data submitted & provide staff education.

Significance:
With heighten consumer knowledge and reimbursement impact on hospital acquired conditions, the data reported must be accurate. Hospital acquired pressure ulcers need to be concurrently review with staff involved in order to increase staff education about preventable strategies and skin management.

Strategy and Implementation:
The strategy has 2 phases; phase one was converting our paper weekly audit to a web based audit. The web –based audit allowed for electronic data collection from any hospital computer and provided timely analysis. The second phase was programming a trigger mechanism to assist in reducing hospital acquired pressure ulcers via concurrent reviews. The trigger is a program that is written into our existing web based auditing tool which sends immediate email alerts to our Wound Ostomy Continence Nurses whenever a unit submits a hospital acquired pressure ulcer. A team of 3-4 Wound Ostomy Continence Nurses then reviews nurse documentation, completes a root cause analysis and performs concurrent assessment of the patient. Additional staff education is provided when needed. The root cause analysis helps identify areas of opportunities and missed opportunities.

Evaluation:
Phase I, a staff feedback survey proved its effectiveness via reports of decreased audit time, improved accessibility and usability. Phase II, the addition of the alert to the WOCN for validation and education reduced acute care hospital acquired pressure ulcer rates from 1.43% to 0.71%.

Implications for Practice:
Concurrent analysis of data submitted will increase staff accountability in correct assessment and auditing as well as enhance their knowledge around skin management. The electronic collection of data will provide the ability to analyze data concurrently and identify areas of opportunity.