Decreasing HAPU in the Acutely Ill Med-Surg Patient

Purpose: Decrease hospital acquired pressure ulcers in acutely ill medical surgical patients with multiple co-morbidities.

Methods:We designed and implemented a Pressure Ulcer Prevention Program (PUPP) for the unit of our acute care hospital that had the highest Hospital Acquired Pressure Ulcer (HAPU) prevalence rate.  We designated skin champions on the unit, and designed identification badges for the entire PUPP staff highlighting the PUPP program and turning schedule.  The education emphasized a “back to basics” approach for all staff members. We instituted a signal device that only the unit staff would recognize and placed the device outside each “at risk” patient room.  There was a similar signal device on the wall above the “at risk” patient’s bed.  Each patient on the program was given a nutrition consult and was to be out of bed at least one hour per day, sitting on a static air seat cushion.  Each patient on the program was also placed in bilateral static air boots.  We eliminated diaper use by application of topical skin barriers and using absorbent disposable under pads. 

Results:During the 12 month period prior to implementing the PUPP program in October 2008 there was a total of 6 HAPUs on this unit.  In the 12 months since implementation there has been only one HAPU.  This is an 83% reduction for one year.  We also decreased our patient’s average length of stay (LOS) on this unit 0.5 days. In summary, this 26 bed pulmonary med-surg unit went from having the highest HAPU rate in our hospital to the lowest plus a decreased LOS.

Conclusion: A comprehensive program that combined education, pressure reduction products, and a signal device, was utilized to significantly decrease our HAPU rate.  We were able to increase staff awareness of prevention and promote best practice for our patients.