Targeting & Simplifying Risk Assessment & Interventions to Eliminate Hospital Acquired Pressure Ulcers

The purpose of this abstract is to describe a risk assessment tool developed to improve quality outcomes for patients by working towards eliminating preventable hospital acquired pressure ulcers (HAPU). Several problems were identified including the fact that despite best practice guidelines and staff training pressure ulcer rates remain high. Prevalence of pressure ulcers has remained constant at about 7% over the past 20 years, even though considerable time and money have been invested in various prevention strategies. 498 HAPU’s occurred at our system-wide institutions over a 1year period equaling one patient every 17.5 hours. These current problems contribute to variations in preventative care practices, differing levels of compliance in this area of care, risk assessment does not always correlate to care interventions, and patients at risk not consistently receiving adequate preventative care.

Current literature recommends skin and risk assessment performed daily for acute care and implementation of interventions to prevent pressure ulcers guided by risk assessment findings. The current state at our facility did not correlate with literature recommendations. These findings paved the way to identifying ways to simplify the process used by staff to identify patients at risk for developing pressure ulcer and customizing interventions driven by the risk assessment to the risk factors relevant to each patient. This process initiated a Rapid Improvement Event involving system-wide multidisciplinary staff with the common goal to prevent HAPU’s. The risk tool was simplified eliminating the numerical rating scale, decreasing the risk categories to 4 rating levels and simplified interventions to be completed. A skin bundle intervention list was then created with a pilot with chart review completed requiring revision of the intervention bundle.

After revisions, the HAPU risk assessment tool was implemented system-wide within the last week of October 2010 with adaptation of documentation systems to facilitate charting assessment and care.