Continuous Quality Improvement: Initiatives For Pressure Ulcer Prevention

Purpose:
The purpose of this session is to describe how implementation of a continuous quality improvement program has resulted in a significant decrease in hospital acquired pressure ulcers (PU) as a result of collaboration between the Performance Improvement (PI)/Nursing Leadership and staff nurses.

Significance:
Pressure ulcer prevention remains a key nurse sensitive indicator. Yearly, healthcare costs related to PU is over $11 billion. Hospitals must ensure they have adopted a stringent PU monitoring process that evaluates PU prevention strategies as well as hospital acquired PU.

Strategy and Implementation:
To ensure a rigorous PU monitoring process this 610-bed academic Magnet medical center conducts PU prevalence monthly. A multidisciplinary pressure ulcer committee(PUC) and a robust PI team are responsible for coordinating PUP data collection, analysis and dissemination of metrics to the front line staff. Unique to this facility, the monthly PUP monitoring program is assumed by direct staff. These direct staff, PI Analysts, collect PUP data via bedside observations, serve as expert to their peers, assist novice nurses with PU staging and identifying specific prevention strategies for at risk patients. The PI analysts receive monthly education from the Wound Ostomy Continence Nurse (WOCN), which is then shared on their nursing unit along with unit PUP rates. In turn, staff members of the PUTF also receive monthly education via the WOCN, review evidenced based practices for PU prevention/treatment and work with the PI analysts to ensure care to our patients is consistent and safe.

Evaluation:
This monthly continuous quality improvement model has yielded the facility to consistently surpass the Hospital acquired PU prevalence rate when benchmarked against the NDNQI mean in the Academic Medical Center cohort of eight out of eight quarters.

Implications for Practice:
Sustained quality improvement requires dedication and collaboration between disciplines throughout the healthcare organization. This continuous quality improvement model demonstrates collaboration and engagement amongst several disciplines to reduce hospital acquired PU.