Changing Culture Leads to Decreased Hospital Acquired Pressure Ulcers

Purpose:
The purpose of this quality improvement project was to change the culture of indifference to one of engagement and thereby decrease the hospital's number of hospital acquired pressure ulcers (HAPU).

Significance:
Pressure ulcer development is a significant quality of care indicator. A belief that as patient acuity and complexity increases, pressure ulcer prevention loses priority. The indiffernce culture translated into HAPU rates of greater than 10%.

Strategy and Implementation:
With strong administrative and managerial support, representatives from each of the hospital's patient care areas were selected to comprise the Skin Savers team. The team met monthly under the direction and guidance of the Wound/Skin and Quality Departments. Meetings agendas focused on the conduction of pressure ulcer prevalence studies utilizing the NDNQI format, discussion of results through real time data entry and analysis and education related to pressure ulcer prevention and other skin issues. Each Skin Saver would then disseminate individual unit prevalence study results and educational information within their units via meetings, bulletin boards and educational programs. Additionally, the Skin Savers would champion their unit's pressure ulcer prevention efforts through leadership, expertise and continued education. To foster team identity and recognition throughout the hospital, a Skin Savers logo was created and scrub tops with the logo were purchased for each team member.

Evaluation:
The Skin Savers program changed the culture of indifference to a culture of engagement throughout the hospital. Hospital acquired pressure ulcer rates achieved the original hospital goal of 6% and were able to further decrease the rate to 2% and have been sustained over an eight month period.

Implications for Practice:
Implementation of a team of healthcare professionals whose mission is to provide leadership, expertise, and education related to pressure ulcer prevention can be instrumental in changing a hospitals culture, thereby significantly decreasing and sustaining hospital acquired pressure ulcer rates.