The impact of nurse-driven pressure ulcer prevention rounds on hospital-acquired pressure ulcers

Purpose:
The goal of the nurse-driven pressure ulcer prevention rounds is to identify patients at high risk for pressure ulcers and implement appropriate interventions to reduce the rate of hospital acquired pressure ulcers(HAPUs).

Relevance/Significance:
Hospital acquired pressure ulcers have been linked to increased length of stay and patient mortality. Our organizational prevalence rates reflect stagnant numbers of HAPUs in high risk areas. We recognized a need for additional interventions to supplement the certified wound care nurse consult team (WCCT) and unit-based skin care nurse resource program and to shift the focus from pressure ulcer treatment to pressure ulcer prevention.

Strategy and Implementation:
Due to implications for national reporting and reimbursement, our physician colleagues collaborated in interprofessional prevention and treatment efforts. In 2014, a team comprised of WCCT, nursing leadership, physical therapists and vascular and plastic surgeons initiated twice weekly rounds on patients with HAPUs for consensus staging of mixed etiology or complex wounds. The initiative also included nurse-driven prevention rounds on high-risk units. The purpose was to identify patients deemed high risk for HAPU development and implement appropriate interventions based on Braden subscale categories. The team for prevention rounds included a wound care team member, Clinical Nurse Specialists, nursing leadership and direct care staff. The team developed specific criteria to select patients at highest HAPU risk. Standardized data, including team recommendations was collected and entered into a database.

Evaluation:
Prevention rounds were conducted on a total of 265 patients. 88% of patients had no HAPUs present at discharge. The most frequently recommended interventions from the team were used to target 2015 educational programs. Since the inception of prevention and staging rounds there has been a 33% decrease in hospital HAPU rates with a 66% decrease in ICU rates.

Implications for Practice:
Hospital acquired pressure ulcers are directly attributed to nursing care. A collaborative approach to HAPU rounding and prevention that includes direct care staff, nursing leadership and clinical nurse specialists decreases HAPU rates and improves patient care outcomes.