OBJECTIVE: To identify etiologies in the critical care areas contributing to the pressure ulcer prevalence rate. To then develop prevention and treatment guidelines promoting skin integrity while preventing pressure ulcers. The team consisted of nurses, dieticians, pharmacists, and physical therapists who examined the assessment, prevention, and treatment of pressure ulcers. We discovered the critical care nursing staff could perform the Braden Scale risk assessments, but they depended on the Wound, Ostomy, and Continence Nurses (WOCN's) for decisions about preventing and treating pressure ulcers, and awaited the WOCN consult before initiating care. Using evidence based practice guidelines, the team, in collaboration with the WOCN's, developed prevention and treatment algorithms. The prevention algorithm identified low subcategory Braden scores and triggered appropriate prevention strategies. We also developed a nutritional algorithm. We developed an educational fair for the nursing staff demonstrating the use of specialty beds and wound care products within the algorithms. We began monthly prevalence surveys in the critical areas to test our plan and identify additional opportunities for improvement.

RESULTS: The nursing staff rapidly integrated the algorithms and guidelines into their practice resulting in a relative risk reduction of 22.1% in the Hospital 's critical care population. The hospital prevalence in May 2005 was 2.6% with an incidence rate of 7.5%. Though still implementing our plan, we anticipate these efforts will further reduce the prevalence of pressure ulcers at Stanford Hospital. The patient safety problem identified by the CalNOC data was the basis for this interdisciplinary team which is improving patient outcomes.