STOP Pressure Ulcers Campaign

Purpose:
To reduce hospital acquired pressure ulcers by introducing a house-wide STOP Pressure Ulcers campaign that includes new alert signage, electronic dashboard indicators, daily monitoring reports, current number of patients with pressure ulcers, and a review tool for newly documented pressure ulcers.

Significance:
Hospital acquired pressure ulcers increase patient discomfort and may contribute to morbidity and mortality as well as length of stay and cost of care. Developing new strategies and tools for prevention will improve outcomes, length of stay, costs, and possibly assist with decreased readmissions.

Strategy and Implementation:
Our goal was to strengthen our pressure ulcer prevention program through increased awareness. Ultimately, this program should lead to an improvement in our culture of safety and decreased hospital acquired pressure ulcers. We developed a campaign titled STOP Pressure Ulcers, where S=skin assessment every shift, T= turn/reposition every 2 hours, O=optimize nutrition, and P=protect from moisture. Alert signs were created using the STOP slogan and placed on doors of patients with a Braden score of 18 or less. New updated education for all bedside nurses, care partners, and dieticians was developed and implemented house-wide. In addition, new monitoring tools were introduced which included daily reports and real-time feedback every shift. Standardized Safety Rounds, focusing on fall and pressure ulcer prevention, provided performance coaching and mentoring opportunities for both unit leaders and bedside nurses in the actual prevention interventions for individualized patient risk factors.

Evaluation:
STOP alert signs are in use on all units, bedside staff educated, managers receive a daily report,a Braden indicator is displayed on all clinical workstations. Since implementation the number of patients with hospital acquired PU has decreased 50 percent per NDNQI data from May 2011 to May 2012.

Implications for Practice:
The use of multiple strategies to improve a culture of safety was successful in reducing pressure ulcers in our patients. These strategies (education, monitoring, reminders and feedback) may be used to improve other problems that affect patient safety.