Nurse Driven ICU Pressure Ulcer Prevention Bundle Leads to a Reduction in Hospital Acquired Pressure Ulcers (HAPUS)

Purpose:  Nearly 60,000 patients die annually from complications related to HAPUS; treatment cost ranges from $2,000-$70,000 per wound with the average cost for each hospital ranging from $400,000-$700,000 annually. ICU patients are at a higher risk for HAPU development, incidence can range from 5.2-20%.  The primary purpose of this quality improvement initiative is to decrease HAPU rates in the ICU.  Additional goals include:  improving documentation, strengthening multidisciplinary relationships and empowering the nursing staff in coordinating bundle implementation.

Methods: Implementation of the ICU Pressure Ulcer Prevention Bundle began in 2/2009 and focused on nursing sensitive measures.  Several bundle components are incorporated from the NDNQI data collection tool utilized for our monthly prevalence study.  Other components include:  risk assessment and skin condition discussed on daily rounds with the team, bi-weekly multidisciplinary collaborative rounds are conducted to identify patients at high risk; nutrition consults are conducted proactively to look at nutrition status and glucose control; risk assessment and skin condition discussed during all RN to RN SBAR (situation, background, assessment, recommendation) reports; focus on RN/MD documentation related to risk assessment, skin assessment and pressure ulcer documentation is emphasized; education related to NPUAP staging definitions, wound care products and pressure redistribution surfaces were provided to staff; bundle components are incorporated into monthly quality data reports.

Results:  Since implementation, data reveals HAPU prevalence has been zero 7 out of 16 months. RNs promote change by ensuring bundle compliance and multidisciplinary engagement. The greatest successes to date have been RN's empowerment and MDs engagement in the collaborative approach to bundle compliance.

Conclusions: Sustaining success will be facilitated by focusing on nursing measures related to pressure ulcer prevention which include: collaborative approach, emphasis on prevention & risk assessment, frequent audits of compliance & daily discussion of HAPU bundle components with the multidisciplinary team.