Zeroes are for Heroes: One Hospital's "Blueprint for Action" to Reduce & Prevent Pressure Ulcers

Our HAPU rate exceeded the NDNQI 90th percentile, indicating an urgent need to improve clinical nursing practice and patient outcomes. The goal was to improve organizational performance and reduce HAPU prevalence rate form 17.2% in 6/09 to 3.5% or less in 3/10 utilizing a rapid cycle PI initiative. Several of our patients had significant complications from HAPU that resulted in an overall reduction in their quality of life. Costs associated with these reportable events were significant and directly reflected clinical practice issues. Despite active PI plans, the prevalence of HAPU had continued to increase. In response, a multifaceted "Blueprint for Action" was developed by the CNO and CWOCN that included unit-based Skin Resource Nurses and a revitalized multidisciplinary wound team. A review of literature and best practices were conducted, leading to a full revision of the guidelines for wound care. Evidence-based practice guidelines for pressure ulcer prevention and management were developed and integrated into day to day EMR documentation and treatment records. Pressure Ulcer Prevalence studies were increased from quarterly to monthly and conducted by the Skin Resource Nurses. Revisions to skin care practices included changing the hospital formulary for skin care products achieving the best in skin protection, healing and cost effectiveness. Skin care education was key; the CWOCN and Skin Care Resource Nurses were responsible to implement interventions, educate staff, and lead by example. The "Blueprint for Action" was extremely successful; by 3/10 the HAPU was reduced to 2.8%, well exceeding our goal. Our current rate is 0.9%. Units are recognized through a "Zeroes are for Heroes" Campaign in which units achieving a 0% HAPU rate are celebrated. A pressure ulcer prevention program founded on evidenced based practice that is driven by bedside nurses, focuses on accountability, empowerment and recognition can decrease the rate of HAPU, thereby improving patient outcomes.