Happy skin: Preventing hospital acquired pressure ulcers through a SKIN bundle and staff text reminders

Purpose:
In the United States, acute care hospital acquired pressure ulcers (HAPU) are becoming increasingly common despite preventative guidelines. In 2011, despite Braden Scale use, 16 HAPUs occurred on our Medical/Surgical floor prompting the development of this evidence-based prevention project.

Significance:
Pressure ulcers result in increased pain, infection, longer lengths of stay, amputation and complications. The estimated average treatment cost of a pressure ulcer per hospital stay is $ 43,180.00 with the total cost of treating pressure ulcers is estimated at $11 billion annually.

Strategy and Implementation:
In 2012, a team was developed where processes and challenges were reviewed. Then, through the Clinical Excellence Through Evidence-based Practice (CETEP) method we developed an evidence-based prevention project to reduce our incidence of HAPUs on our Medical/Surgical unit. In addition to our already established Braden Scale Assessment and interventions we instituted a skin bundle. The SKIN BUNDLE includes: skin assessment, keenly documenting, initiating wound order sets, and nursing interventions based on Braden Scale. We also used an innovative multilevel team approach to keep direct patient care nurses engaged through the use of text messages. Every two hours staff are reminded to reposition their patients via a text saying “Move It! Move it!”

Evaluation:
After implementation of the EBP project, our incidence of HAPU decreased from 16 in 2011 and specifically 7 in October 2012 to 4 in March 2013. Although our goal is zero, the implementation of our SKIN Bundle has shown a significant drop in HAPU rates.

Implications for Practice:
The success of this project has promoted a valuable future hospital wide initiative. In addition, by using an innovative text messaging practice within our bundle, which is an opportunity for other hospitals, we were able to remind our staff members of the vital role in eliminating HAPU.