After reviewing the increasing data for pressure ulcers in a Medical Intensive Care Unit, it was apparent that an innovative practice change was needed to generate increased vigilance of pressure ulcers.
The purpose of this presentation is to demonstrate that heightened focus of front-line staff, as well as multidisciplinary teams, impacts the results towards decreasing hospital-acquired pressure ulcers.
A 12-month goal was established with clear objectives to decrease the number of hospital acquired pressure ulcer development on a Medical Intensive Care Unit by at least fifty-percent by the end of the year 2010.
The first step was to identify enthusiastic front-line staff members who were motivated and eager to champion the initiative. While working with the Institute for Healthcare Improvement (IHI) and Los Angeles County Department of Health Services (DHS), the unit implemented various best practice changes. Practice changes that were implemented included: visual cues placed on each patient’s door indicating whether they had existing pressure ulcer or was at high risk, two-nurse "four-eyes check" skin assessments upon admission, a pressure ulcer calendar posted centrally in the unit for staff to see immediate daily progress, staff education on proper pressure ulcer identification and documentation. A zealous nursing attendant took charge of monitoring the patients turn schedules. Daily managerial rounding, pressure ulcer data collection, and bi-weekly stakeholders (administration, nursing, CWON) meetings on progress were conducted.
Extraordinary positive results were manifested, not only were the goal of decreasing pressure ulcers by fifty-percent achieved, the Medical Intensive Care Unit also gained other achievements such as: 0% pressure ulcer development over one quarter, increased staff participation/ownership for improvements and development of staff leadership for initiatives.
Interventions promoting vigilance of pressure ulcers and implementation of best practices impinge upon the number of hospital-acquired pressure ulcers.