Purpose: Establish a program to ensure safety to a veteran population resulting in a decrease of incidence of pressure ulcer development in the inpatient areas.

 Objective: To complete a facility assessment (July 2004) and identify the current prevalence and incidence, level of knowledge related to prevention strategies and wound etiology. The wound care team reviewed & revised the following: 1) current policies and procedures for wound care and pressure ulcer prevention, 
2) Documentation system for the assessment of wounds, preventative care, and reporting of incidence which was consistent with current evidence based practice. Ongoing surveillance of the "at risk" population and support for prevention strategies to include support surfaces, product standardization and availability, and analysis of all incidents of pressure injury were a focus for the wound care team. The establishment of an Interdisciplinary Wound Care Team to participate in the development of a comprehensive Wound Care Program to enhance prevention and treatment across the continuum of care within the Greater Los Angeles Healthcare System. The Wound Care Team provides orientation education to all nursing employees within their first 2 weeks.

 Outcome: The incidence rate (# PU hospital acquired/1000 pt days) in July 2004 was 9.5%, which included all stages, DTI and unstageable pressure injury. Over the course of analysis of the incidents we recommended and instituted product changes and nursing practice changes. Within two years we had seen a decrease of incidence by 50% and a decrease in the number of full thickness injuries. The incidence rate dropped to a rate of <2 for the entire acute and LTC population by the end of the third year where 87% of those being partial thickness injury.  The wound care team has been successful in a cultural transformation toward PREVENTION.