The COA was based on three key initiatives: 1) Training; 2) The implementation of Braden scale assessment each Monday, Wednesday, and Friday ; 3) The purchase of pressure redistribution beds to accommodate all  patients.  The definition of an “at risk” patient was reduced from 18 to 16 on the Braden Scale.

The initiative has now been in place for a period of 33 months over which a nearly 14% prevalence of NPUs was reduced to 5% and often less (where the average patient population is 94 patients and 0.9 patients represent 1%). 

Now that NPUs are far less frequent we are able to focus on those we observe and implement remedial action where necessary.  It is our belief that formal institution-wide protocols are vital to the reduction and elimination of NPUs.  Reducing NPUs in critical care patients remains a challenge.  We thought that placing most, if not all, critical care patients on pressure redistribution beds would have a greater impact than it did; this confirmed that no one therapy presents a complete solution.  The early outcome of the COA was presented at the Mayo Clinic October 2007.  This paper deals not with the protocol itself, but what we have learned to further improve the COA to further reduce or eliminate NPUs.