Prevent Ulcer Developement Specialists

Abstract

Purpose 

A marked increase in pressure injuries was identified on a geriatric mental health unit. Root cause analysis noted poor compliance with skin care regimes, use of non-formulary products, failure to intercede for high risk patients and inconsistent tracking methods. The purpose of this study was to decrease nosocomial pressure injuries using an evidence based pressure ulcer prevention program. 

Methods

A multi-disciplinary team was created. The team consisted of unit director, quality director, pharmacist, staff RN and mental health tech.  Led by the wound, ostomy and continence nurse the team was named Prevent Ulcer Development Specialists (PUDS) and went to work implementing evidence-based guidelines. 

The comprehensive prevention program included six elements; assessment/reassessment, daily skin inspection, management of moisture, optimizing nutrition, maintaining hydration and minimizing pressure.  These elements were integrated in practice with a photograph of skin condition and a dietician evaluation on admission.  The Braden Scale was used to assess patient risk daily.  The wound care protocols were added to the medication administration record and the WOC nurses conducted regular rounds.  Concurrent audits were completed for compliance.  Tracking of formulary product turnover thru the purchasing department provided objective usage data.

Results

The ulcer rate dropped from 0.978% in 2006 to 0.298% in 2007 and to 0.297% in 2008.  There were no pressure ulcers on the unit in 2009 through the first half of 2010.  The PUDS group continues to evaluate ulcer prevention at staff meetings to maintain awareness and promote vigilance.  As compliance increased and rates dropped, celebrations such as a root beer float party dubbed "Suds for PUDS" were held to recognize staff for their success in skin care protection.

Conclusion

A comprehensive ulcer prevention program can dramatically decrease the incidence of pressure ulcers.  The importance of engaging frontline staff in unit change is a number one priority.