Increased Collaborative Practice in Action! The Results: Decreased Hopsital Acquired Pressure Ulcers

Over 2.5 million people in the United States are affected every year by the development of a pressure ulcer which results in undesired pain and suffering as well as an increasing financial burden to our health care system.  Research indicates that the estimated cost of pressure ulcers can be as high as $11 billion dollars and more than fifty thousand people die every year as a result of pressure ulcer complications. In October of 2008, CMS selected pressures ulcers as one of eight reasonably preventable conditions for which hospitals will no longer receive additional payments if not present on admission.

In January 2008, our facility launched an initiative aimed at increasing the identification of pressure ulcers present upon admission and decreasing the number of hospital acquired pressure ulcers.  To achieve these goals, a Rapid Improvement Team developed and implemented a Wound/Skin assessment and screening tool to be completed upon admission by staff nurses in all inpatient and procedural areas.  In addition, a consultation process was implemented where staff nurses electronically entered a consult for Wound Ostomy Services when there was any indication of skin impairment related to pressure.  All patients are screened on admission for skin impairment. Staff nurses assess and thoroughly describe all wounds but do not diagnose or stage.  Wound Ostomy Services then collaborate with staff nurses and physicians to determine etiology of wounds and stage if pressure related.

Since implementation of the new process, our pressure ulcer rate has declined from a mean of 3.5% to 0.02% the last quarter of 2008 and 0.05% or less for 2009.  We can attribute these results to several factors: hardwired admission assessment process, increased awareness of the importance of skin assessments, increased collaboration between staff nurses, Wound Ostomy Services and physicians, and enhanced training for staff and nursing leaders.