The WOCN Society 40th Annual Conference (June 21-25th, 2008)


Consistent Implementation of a Pressure Ulcer Prevention (PUP) Bundle

Kathryn L. Jackson, RN, MSN, CRRN, Columbus Regional Hospital, Clinical Nurse Specialist, 2400 E. 17th Street, Columbus, IN 47201

The purpose of this abstract is to describe consistent implementation of a pressure ulcer prevention (PUP) bundle.

The objective is describe movement of nursing practice towards recognition of the at-risk patient, implementation of a pressure ulcer prevention bundle and the resultant reduction of hospital acquired pressure ulcers.

In 2006, Columbus Regional Hospital (CRH) created a pressure ulcer prevention (PUP) bundle modeled on similar bundles found in critical care. A review of the literature resulted in selection of four key indicators for the bundle: moisturizer or moisture barrier, nutrition consult, support surface and documented turns at least every 2 hours. Although the skin care committee tracked the PUP bundle during quarterly surveys, salience among the bedside nurse in using the bundle was not high and, consequently, quarterly pressure ulcer survey results were inconsistent across units. Few units had skin care champions and they were not highly effective in influencing and maintaining unit survey results.

In 2007, the skin care committee made several decisions to move the practice of pressure ulcer prevention forward including: movement from quarterly to monthly prevalence surveys, movement from reporting data in terms of meeting NDNQI benchmark to including PUP bundle rates on a monthly basis, additional training for skin care champions, movement from monthly to bimonthly committee meetings to facilitate rapid cycle testing, implementing PUP bundle on a pilot unit then hospital wide, and empowering the skin care champions to develop innovative methods of influencing peers on their respective units.

Outcomes: The pilot unit was the intensive care unit (ICU). The ICU has moved from a 28% rate of hospital acquired pressure ulcers to 0% in 2008 with the exception of 2 pressure ulcers in an actively dying patient. Other units have made similar reductions.