The Pressure Ulcer Prevalence Study: Facility Demonstrates Quality Improvement in a 3-Year Retrospective Review

TITLE:  From Good to Great to Built to Last: Creating a Lasting Passion for Pressure Ulcer Prevention and Management

The Pressure Ulcer Prevalence Study: 
Facility Demonstrates Quality Improvement in a 3-Year Retrospective Review
Introduction:
A 340 bed acute care Chicago hospital complies with the National Database of Nursing Quality Indicators Guidelines requiring quarterly pressure ulcer prevalence studies.  The Wound Ostomy Continence Nurses Society defines “pressure ulcer prevalence as the number of patients with at least one pressure ulcer who exists in a patient population at a given point in time.”
NDNQI states that “the purposes of the Pressure Ulcer Prevalence Survey (PUPS) are to determine the prevalence of hospital and unit-acquired pressure ulcers and explore the relationship between nursing assessments performed, interventions used, and the development of pressure ulcers.”
Methods:

The quarterly PUPS is a one-day head-to-toe skin assessment of all the patients on our medical-surgical, critical care, skilled nursing and rehabilitation units.    

The patient assessment teams are comprised of RN members of the Skin Management and Assessment Resource Team (“SMART”), who completed the NDNQI pressure ulcer training, and CNAs or nurses in orientation.  The teams are assigned to conduct the assessments on units other than their own, to prevent bias.  Each patient assessment is documented and highlights the pressure ulcers and stages.  A 30-minute pressure relief recheck of suspected stage I pressure ulcers is conducted by the team and the CWCN.  Unit Managers and Educators are the chart reviewers on their own units.  The CWCN compiles the data and submits a thorough report, highlighting trends and recommendations.

Results:
The three years represented, 2006 – 2008, demonstrate a significant improvement in the reduction of hospital-acquired pressure ulcers from 14.3% to 2.9%.  With the support of hospital and nursing administration, new leadership and “SMART” membership, we improved patient care through staff education, behaviors, and resources.  A dramatic improvement was evident after the purchase of new low air loss pressure redistribution surfaces.  Education brought skin and wound care to the forefront of nursing at this Chicago Hospital.