From the Top Down: Decreasing Unit Acquired Pressure Ulcer Rates - A Cleveland Clinic Experience

This presentation will elaborate on the process and outcomes associated with a deliberate, structured approach to pressure ulcer reduction that resulted in a 70% decrease in prevalence.  Recent regulatory changes in the way that hospital acquired pressure ulcers are reimbursed puts nursing practice front-and-center in the skin care arena.  The rules may have tightened, but nursing interventions remain the key in preventing and treating pressure ulcers. The agencies that judge fitness for reimbursement and accreditation focus on prevalence, and compliance with assessment, treatment, and documentation.  The 42-bed Surgical Intensive Care Unit of this international tertiary referral medical center formed a project team to address escalating pressure ulcer prevalence. The goal was to identify issues that impact the incidence of unit-acquired pressure ulcers in a setting where every patient is at high-risk for their development. From the five hour collaborative session thirteen most wanted improvements (MWI) were identified by the team. The MWIs served as a bundle of interventions – each having individual merit, but collectively created a synergy that fueled the project.  Each MWI was assigned an owner selected from the team members.  Time, resources and cooperation across service lines were critical to the team member’s progress.   The dramatic reductions in unit-acquired pressure ulcer rates were attributed to the thirteen initiatives that formed the core of the pressure ulcer bundle. The project, which could be translated to any practice setting, emphasized and achieved collaborative relationships that increased the strength of the change and served as the source of energy to sustain the project now at its conclusion.