Reducing hospital acquired pressure ulcer by using an evidence-based standardized nursing procedure

PURPOSE The hospital acquired pressure ulcer (HAPU) rate at a forty bed medical-surgical unit was much higher than the California Nursing Outcomes Coalition database project (CalNOC) benchmark (6.07% versus 3.38%). The purpose of the study is to reduce the number of HAPU by implementing an evidence-based standardized nursing procedure. OBJECTIVES Strategies were developed to increase compliance in the implementation of evidence-based standardized nursing procedures in an effort to reduce the HAPU rate. METHODS After literature synthesis, an evidence-based pressure ulcer prevention bundle was created into a nursing standardized procedure. Staff education through posters, one on one peer teaching, elevator speech, and documentation audits were completed. If the patient's admission Braden scale score was less than or equal to 18, the following prevention bundle could be initiated: turning every 2 hours, utilizing an air mattress overlay, assessing the patient's pre-albumin level, initiating a wound care referral and/or dietitian referral, and ordering heel pressure relief devices and/or a wheel chair cushion. OUTCOMES With the implementation of this pressure ulcer prevention nursing standardized procedure, the HAPU rate was significantly decreased from 6.07% to 0.62% a year later (2008 versus 2009) on this particular Medical-Surgical unit. The successful experience was then disseminated throughout the whole hospital; creating a reduction in house-wide HAPU rate to near zero. Nursing staff were able to initiate preventive care upon patient admission without waiting for physician orders. The intervention also promoted healing of community acquired pressure ulcer by 40%. The study built awareness of device-related pressure ulcers as well.