PROBLEM: Pressure ulcer prevalence and incidence are useful tools to identify clinical practice problems, but the process for capturing and interpreting incidence remains elusive. In the past, incidence at this facility was determined based on retrospective chart reviews leading to a discrepancy between incidence and prevalence trends.

METHODOLOGY: For the past year, this 400 bed Magnet hospital has required that staff complete an electronic incident report upon discovery of any stage 2+ pressure ulcer. The CWOCN receives all “skin integrity” incident reports and maintains a spreadsheet of findings. Some of the issues that have emerged from this attempt to determine incidence have been: 1) how do staff know that a report has been submitted? 2) how do we capture the deterioration of a pressure ulcer? 3) how accurate is the data submitted? 4) how much data is worth collecting about every incident and which data are most meaningful? 5) is there a way to find “missed” pressure ulcers when there is a failure to enter an incident report? 6) is there a way to help staff perceive value in taking time to complete incident reports? 5) is there a way to benchmark our data against similar hospitals?

RESULTS: The process of collecting meaningful pressure ulcer incidence has been challenging and time consuming. We have confirmed that our elderly population with pressure ulcers are usually poorly nourished, and have found some trends associated with diagnoses. As we iron out the problems with “how to collect” the data we are finding our incidence and prevalence trends coming into alignment.

SUMMARY: The process of collecting accurate real-time pressure ulcer incidence has been a challenge. This is the story of our journey toward meeting those challenges and improving that process.