Aligning the Stars to Reduce Nosocomial Pressure Ulcers

Background:  The prevalence of hospital-acquired (nosocomial) pressure ulcers is seen as an indicator of the quality of nursing care.  Certified Wound, Ostomy and Continence Nurses (CWOCNs) working in acute care are often responsible for monitoring nosocomial pressure ulcer prevalence and incidence and for instituting programs to decrease or eliminate them.  It can be a daunting task for a staff of one or two individuals to attempt a cultural change in a huge institution. 

Purpose:  To produce sustained reduction of nosocomial pressure ulcers throughout a large acute care facility.

Objective: To describe the myriad of influencers contributing to a dramatic decrease in nosocomial pressure ulcers.

Methods:  Pressure ulcer prevalence studies from 2004 to 2009 in a 506 bed not-for-profit hospital showed a hospital acquired (nosocomial) pressure ulcer prevalence of 5 – 6% or higher.  Repeated efforts to reduce this prevalence by a staff of 1.6 FTE CWOCNs and skin care representatives from nursing units were ineffective until multiple influencers, or “stars” throughout the organization began working in unison towards the goal of reducing nosocomial pressure ulcers in the Fall of 2009.  From administration to staff development, to nursing to materials management, all departments focused on the target of reducing nosocomial pressure ulcers.   Success in one unit stimulated other nursing units to strive for equal improvement. The synergistic effect of the “alignment of the stars” resulted in a cultural change throughout the hospital.

Results:  Quarterly nosocomial pressure ulcer surveys documented a prevalence below 5% in the first quarter of 2010, below 4% in the second quarter, and below 3% in the third.  Retrospective interviews and analysis identified the “stars” that aligned to produce this dramatic and sustained improvement.