CWOCNs Lead a Collaborative Approach to Sustained Improvements in FAPU Rates

Purpose:
As members of Ascension Health, St. John Hospital is dedicated to the prevention of facility acquired pressure ulcers (FAPU). Our purpose is to showcase innovative approaches to attaining and sustaining reduced FAPU rates through utilizing wound care nurses and the S.K.I.N. Ž bundle.

Significance:
Pressure ulcers impact patient comfort and healing, as well as added expense and length of stay (LOS). Increased LOS varies from 13-23 days and can impact costs that exceed $1 million annually. The effects of negative outcomes jeopardize institutional viability and detract from our mission.

Strategy and Implementation:
Prevention of FAPU is enmeshed in Ascension Health's goal for Healthcare That Works, Healthcare That Is Safe and Healthcare That Leaves No One Behind, For Life. Through continuous quality improvement, we systematically implemented the S.K.I.NŽ. bundle. “S” represents purchase and selection the appropriate support surfaces. “K” is to keep the patient moving. Unit turn teams and communication boards were developed, attention was paid to pressure relieving devices; patients and families were educated to shift their weight. “I” prompts incontinence management via moisture proof barriers and the reminder to offer toileting every two hours. “N” corresponds to nutritional status. Education corresponding to the role of nutrition and adequate protein intake was needed. Triggers and processes for oral supplementation and dietary consultation were developed. Wound care nurses are utilized for consultations related to early prevention and detection of FAPU.

Evaluation:
January 2005 rates began at 4.8%. Rates have stabilized at 0.7% for FY2012. Device related rates have decreased to 0.02% through collaboration with respiratory care and CWCONs. Incidence of FAPUs is reported at daily safety huddles and monthly to leaders.

Implications for Practice:
The S.K.I.N. Ž bundle has created a uniform process for reduction of FAPUs. Utilizing CWOCNs reinforces the education and advanced assessment skills. Drawing on continuous quality improvements aligns organizational priorities while collaboration through HEN promotes sharing of best practices.