Under Pressure: Our Journey to Reducing Hospital Acquired Pressure Ulcers

Purpose:
The purpose of this study was to implement strategies to reduce the incidence of hospital-acquired pressure ulcers. Strategies included focused rounding, moisture management, prevention and treatment algorithms, skin care resource nurses, and electronic medical record enhancements.

Significance:
A hospital-acquired pressure ulcer is considered a preventable condition by Centers for Medicare & Medicaid Services, which restricts hospital reimbursement. Hospital-acquired pressure ulcers also increase morbidity and hospital length of stay, as well as patient pain and suffering.

Strategy and Implementation:
The first strategy implemented was focused rounds involving the WOCN making weekly rounds in high risk areas with the clinical nurse specialist or unit based skin resource nurse. Moisture management was noted as an issue on rounds so education was developed on use of moisture barrier creams, absorbent underpads, and foam dressings for bony prominences Pre-operative placement of sacral foam dressings was piloted on vascular and cardiac surgery patients and eventually spread to all critical care units. Algorithms were developed to empower clinical staff to select the appropriate specialty bed and heel protection based on prevention, treatment, or vascular insufficiency. The skin care resource nurses morphed to Champions of Skin Integrity. Their role is essential for educating staff. Several enhancements were made to the electronic medical record to all more nursing autonomy and improved pressure ulcer assessment and treatment documentation.

Evaluation:
The incidence of hospital acquired pressure ulcers was reduced by over 40% from 2009 to 2012. There was approximately 1.5 million dollars saved over the three year period

Implications for Practice:
Significant cost to the hospital was avoided as well as improved patient outcomes. There was a decrease in restricted reimbursements and ultimately less pain and suffering for patients.