Pressure Ulcer Prevention Measures That Made a Difference

Purpose:
The overall goal of this practice initiative was to reduce hospital acquired pressure ulcers. This was to be measured by reduction in prevalence rates during quarterly studies and incidence rates which are tracked on an ongoing basis.

Relevance/Significance:
Most pressure ulcers are considered preventable. Because of research evidence and a continual improvement in prevention resources, there is a constant call for practice improvements. Practice improvements needed involve education, change in action, and engagement of "frontline" staff who care for patients at risk of developing pressure ulcers. Registered nurses completing patient assessments are critical to identification of pressure ulcer precursors.

Strategy and Implementation:
Many changes have been made between October 2012-present, to facilitate reaching the goal of reduction in hospital acquired pressure ulcers. The following is not an exhaustive list: Changed from the identification of patients with pressure ulcers at daily bed board meeting to the identification of "at risk" patients. Significantly increased orientation time with current and new staff. Increased opportunities for dialogue with nursing leadership and operating room staff regarding pressure ulcer prevention. Increased staff awareness of pressure ulcer prevention through poster presentations. Increased rounding on units by WOCN staff. Held a monthly Pressure Ulcer Prevention Team Meeting; members from each unit attended to learn about prevention, and how to be a resource to their unit. Engaged respiratory therapists who agreed to proactively apply foam over bridge of nose under bipap mask. Prevention activities are constantly repeated, in addition to finding new ways to engage staff.

Evaluation:
From 2012-2013, the incidence of hospital acquired pressure ulcers was reduced by 40%. From 2013-2014 this was sustained, and was well below the mean in comparison to the national database. This achievement is predicted to be sustained for the 2014-2015 fiscal year. Our quarterly prevalence rates are reduced as well, having several quarters with no HAPUs.

Implications for Practice:
The sustained results achieved reinforce effects of evidence-based nursing practice on the reduction/prevention of pressure ulcers. As with other clinical outcomes,bundling of initial assessment and sustained pressure ulcer prevention initiatives demonstrate effective, quality patient outcomes.