WOCN Society 38^th Annual Conference Practice Innovation Poster Abstract Submission “Keeping PUP (Pressure Ulcer Prevention) on a Short Leash”   

Shands Healthcare System consists of seven hospitals, affiliated with the University of Florida.  In Spring 2004, a System-wide team, the “PUP Team”, was formed in response to chart reviews that demonstrated inconsistent documentation with subsequent development of hospital acquired pressure ulcers.  The Team was charged with developing evidence- based protocols and strategies to:

• Identify community versus facility-acquired pressure ulcers
• Prevent facility-acquired pressure ulcers and minimize progression
• Treat and document pressure ulcers
• Track and benchmark data at a site, system and international level

A system-wide “Core” policy was developed to consistently guide pressure ulcer prevention (PUP) and documentation strategies. It also guides the treatment of pressure ulcers in relation to dressings, nutrition, and specialty bed usage.   Every hospital incorporated the use of the Braden Score as the risk assessment tool, with a score of 18 or less triggering PUP implementation.  A chart audit tool to collect data on the documentation of PUP strategies, pressure ulcer assessment and patient/family education was developed and implemented. 

Improvements as a result of the PUP Team's efforts included the redesign of nursing forms to facilitate documentation regarding PUP and treatment.   Staff education was standardized.   A minimum of quarterly prevalence studies was mandated.      Review of this data allowed for specific facility based initiatives to lower prevalence rates and/or to improve the quality of documentation.   

In Spring 2005, Shands Jacksonville's facility-acquired prevalence including Stage I was 8.7%, in 2006, 4.5% and in 2007, 3.1%  with the severity of ulcer stage decreasing.   PUP remains a priority for all nursing staff, and Shands Jacksonville has succeeded in keeping “PUP on a short leash”.

The System PUP Team continues to meet to share best practices, successes and to work together on problems that are encountered.