A Stepping Stones System Wide Culture Change: Virginia Commonwealth University Health System Story

Purpose:  In 2005 VCU Health System (VCUHS) Wound Care Team (WCT) realized the window of opportunity was closing in on October 1, 2008. New CMS regulations and imposed timeline meant we must develop a pressure ulcer (PU) prevention strategy and interventions sooner rather than later.  The WCT devoted time to tackling this national issue and came up with 42 ideas on how to create an environment of zero tolerance to Hospital Acquired PU (HAPU) development. This team brainstormed what a “pressure ulcer utopia” would look like, who the key players would be and how it would positively impact our facility’s problem.

Methods: Previous attempts at grassroots nursing efforts failed to sustain change. After the brainstorming session our team consolidated these 42 ideas into 5 basic streams, focused on: Administration, Equipment, Process Change, Committee Development and Education. From these 5 categories, subgroups were engaged and charged with developing a plan of attack on HAPU. The WCT was mandated by Administration to reduce HAPU by 50% in one year! Instead of a grassroots effort a system-wide approach to change the culture of PU prevention was needed.

Results: Through step-by-step implementation of the 42 ideas the VCUHS WCT reduced its HAPU prevalence > Stage II from 6.3% to 1.9%, exceeding administrations expectation.

 

Conclusions:  Large facilities see PU prevention as a daunting task. Often it is difficult to take the first step with budget limits, nursing shortages and lack of administrative support. With our stepping stones model organizations may start on a path towards sustainable change. Although our journey is not over we continue to challenge our facility to raise the bar, one step at a time.