The Secrets To Our Success-Nurse Driven Initiatives To Reduce Stage 3 and 4 Hospital Acquired Pressure Ulcers

Purpose:
Hospital acquired pressure ulcer (HAPU) prevention and reduction is an imperative nationwide quality improvement initiative. Nurses at Winthrop University Hospital have implemented multiple nursing centered initiatives in an effort to successfully reduce the incidence and prevalence of HAPUs.

Significance:
Prevention and reduction of HAPUs is necessary to improve quality of care and reduce costs at Winthrop University Hospital. HAPUs can ultimately increase morbidity and mortality of patients, while increasing hospital length of stay.

Strategy and Implementation:
Nursing leads a Hospital Wide Pressure Ulcer Prevention and Reduction Committee which is a multidisciplinary team comprised of RNs, MDs, PAs, NPs, and Coders that meets monthly to review and discuss incidence and prevalence data and trends. The team also reviews initiatives and case studies. The key to the success of this committee is the inclusion of frontline RNs and medical residents. Since the inception of this committee there have been many strategies initiated. They include the increased frequencey of HAPU prevalence studies from quarterly to monthly, implementation of unit based SWAT (skin and wound assessment team) program to perform weekly prevalence rounds and education, purchase of 400 new beds, implementation of a "mini RCA" process for real time review of all HAPUs stage 3 or greater, and creation of a nursing "cheat sheet" for all things skin related. All nursing resources and protocols have been published on the Winthrop intranet for easy accessibility for all staff.

Evaluation:
Prevalence of HAPUs stage 2 or greater have been signigicantly reduced in the past two years. Prevalence for stage 2 or greater HAPUs was reduced from 5.53% to 2.99% (acuity adjusted as per NDNQI).

Implications for Practice:
The success of these strategies has empowered front line staff to take ownership of their patient outcomes. There is an increased awareness and accountability. Reductions in HAPUs has provided a safer patient care environment with positon patient outcomes.