Does a Team Approach contribute to preventing Hospital Acquired Pressure Ulcers (HAPU)?

INTRODUCTION
Hospital Acquired Pressure Ulcers (HAPU) are ulcers appearing on pressure areas while the patient is hospitalized. Healthcare organizations’ need to ensure that there are appropriate systems to identify those individuals at risk
It was found that our organization (Sheikh Khalifa Medical City) had approximately 18 HAPU/month. This was so big amount, that effective measures were needed
Materials and methods
A task force was created on May 2009 under the guidance of the Quality Department with participation from Nursing, Physicians, Wound care, Dietary, and purchasing.
Two weekly meetings were initiated and problems identified by the Team were:
§         Lack of communication between the healthcare team about patients at risk
§         Information about the risk identified was not shared with the health care team
§         Pressure Prevention protocols were not standardized
§         There were not enough pressure relieving resources
§         Lack of responsibility and accountability from the nursing team with regards to risk identification and prevention measures
§         Nutritional status and risk stratification were not clearly assessed by physicians
An action plan was created and team members were assigned to focus on the areas listed with timeframes stipulated for completion.
The Nursing Team met separately and came up with an action plan to improve nursing part in this project and the following were initiated immediately:
§         Improve communication of risks identified to the healthcare team by documenting the risk status (Braden scale) on the white boards in units and educating physicians and rest of the team on the importance of reviewing this board daily.
§         Considering all patients with Braden Scale score of 18 or less having high risk prompting to Dieticians and Wound Care Nurses to take action and informing the doctors
§         Initiate turning charts and visual prompts to remind the nursing team of when patients are due for position change and the Charge Nurses, Clinical Resource Nurses, and Unit Manager to ensure that position changes have occurred often enough
§         Ensure that pressure relieving resources were made available
§         Develop Champions for Skin Integrity project on trail in one unit to prevent pressure ulcers from occurring by following standardized protocols and utilization off pressure relieving resources
§         Develop other visual cues to inform patient off the 4 P’s (pumps, potty, pain and position) to improve patients being informed of their care
§         Acknowledgement of units improving on a monthly basis
Results
Short term follow-up shows, that the measures initiated were effective decreasing the monthly prevalence of HAPU from 18 in average to 2 (Figure 1.).
Discussion
Pressure ulcer is a preventable problem. The risk should be realized and proper preventive measures taken. This need continuing education and evaluation. The absence of HAPU reflects