Development Of A Pressure Ulcer Program Across a Univeristy Health System

The Penn Medicine Pressure Ulcer Collaborative was formed to develop and implement a health system wide pressure ulcer program to improve process and outcome measures. The 4 entities include the Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn Presbyterian Medical Center, and Penn Medicine at Rittenhouse/Good Shepherd Penn Partners. The entities range from a large university hospital to a small rehabilitation hospital. An evidence-based practice approach was chosen as a framework to guide the Collaborative’s work. This model incorporates the use of clinical evidence, clinician expertise, and patient’s preferences/values to drive decision making with a goal of quality patient outcomes. After a thorough examination of practices, the following areas were chosen to address: prevention, assessment, management, documentation, clinical expertise, staff education, and patient education. As a result the following practices were chosen to develop and implement: standardized SKIN CARE © bundle, linen reduction campaign, documentation (admission, nursing assessment, and wound specific documentation), Braden subscore interventions, criteria for photography, wound management guidelines, computerized pressure ulcer order sets, support surface algorithm, comprehensive education program for all providers, skin care champion groups, patient and family specific education, and  documentation of family notification. Results include process measures consistently measured above 90% compliance. All four entities showed either a reduction of HAPU or stabilization since our collaborative was formed. Three entities reduced HAPU by 13–22%, with one entity reaching a 0% rate.  The fourth hospital retained a low HAPU of 3%. Development of a comprehensive evidence based pressure ulcer program can improve process and outcome measures. The program was successful in teaching hospitals, specialty rehabilitation hospital and an academic medical center across the health system.