Skin Care: Where Have We Been, Where Are We Going?

Introduction:   Hospital Acquired Pressure Ulcers (HAPUs) are common occurrences in hospitalized patients. Recently this condition began to receive serious attention due in part to the new CMS “Never Event” mandates. There has been a drive to develop evidence-based guidelines that focus on the care of the pressure ulcer and the measures needed to prevent them from developing.

Background:  For the 4^th Quarter of 2007, the HAPU incidence at our facility was 10%. To address this, we embarked upon an aggressive HAPU prevention program with the goal to reduce the incidence to 3% or below within 1 quarter and sustain that improvement over time.

 Interventions:

The project started in September 2007 with a 4-prong approach: Personnel, Product Lines, Protocols, and Education.

A highly qualified nurse with experience in skin and wound management was recruited to steward the program. Skin/wound care product lines were evaluated and upgraded based on best practice.  

We used evidence-based practice to purchase products that would treat wounds at all different stages and help with preventative measures. One important initiative was bed surfaces.  A decision was made to purchase a bed surface, which reduces the cost of the rental product and which comes with a guarantee that if the patient breaks down on the surface a free rental product is provided.    We decided to convert our launderable pad to a disposable, absorbent underpad because our launderable pads did not keep the patient dry after episodes of incontinence.  

Protocols were developed for new products and nurses were given educational sessions on wound staging, the new product line, and wound prevention.  Physicians were given in-depth in servicing on wound staging and wound etiology. 

Results:  After the initiation of the program, the HAPU incidence dropped significantly within one month and its improvement has been sustained over time.