A New Level of Pressure Ulcer Transparency at Virginia Commonwealth University Health System: Daily Pressure Ulcer Incidence Reporting

Purpose: Currently most acute care facilities report prevalence and incidence rates based on quarterly data collection which does not accurately reflect the true scope of the PU problem. These surveys provide data for benchmarking progress and identifying gaps or opportunities for improvement that drives many PU quality efforts. However, quarterly data has limitations and provides no "real tiem" data from which to operate. A system wide daily view of our PU patients was our goal.

Objective: _________Wound Care Team utilized the basic National Database for Nursing Quality Indicators (NDNQI) data collection form for initial PU surveys. In order to take a deeper dive into the health system's PU problem, an enhanced data collection tool was designed to include questions on incontinence, OR procedures, provider documentation and obstales to PU prevention. This enhancement led to creation of "link maps"; a pictoral image of patient and unit relationships. Next, our EMR will generate a daily unit specific PU report and system wide summary for management, clearly making PU rates transpartent at ______________.

Outcome: Collaboration with Information Technology to build a sensible and usable daily report has occurred. Ensuring the accuracy of the report through crosschecking with various concrete measures is necessary. All staff nurses will now be aware of all PU patients on their unit and will ensure appropriate interventions are in place. Daily reports will increase PU awareness and unit accountability. Timely causal analysis by unit based nursing leadership and implementation of interventions will translate into improved patient outcomes. Administration now has the transparent "big picture' available and will address PU concerns each morning at daily patient safety rounds.