Implementing a Pressure Ulcer Prevention Program Using Rapid Performance Appraisal

Evidence based practices (EBP) for preventing pressure ulcers are well known and taught. Still the incidence of pressure ulcers remains high. Little time is spent in performance appraisal to quantify implementation of those best practices. This implementation strategy is measurable. The goal of this program is a pressure ulcer reduction of fifty percent in sixty days. Incidence will be used as our outcome. Rapid performance appraisal (RPA) of caregivers best practices is the intervention.  Nursing assistants are most often delegated the wound prevention of patients. Baseline data of best practices will be gathered on each nursing assistant by performance appraisal of thier care of two patients. Patients must be documented as at risk for pressure ulcers using the Braden Risk Assessment. The RPA measures how many of the six best practices were achieved at point of care. Implementation phase begins with RPA of best practices for two patients of each nursing assistant every shift. Feedback is immediately given as a score that is the percentage of the six best practices accomplished. Quantifying and documenting RPA daily for each nursing assistant generates the data to know the individual nursing assistant's performance of best practices as well as the performance of the group. Performance can be benchmarked and compared with incidence rate weekly. As ownership for the reduction of pressure ulcers on the unit is encouraged, stakeholders are developed making the best practices less likely to extinguish over time. As the delivery of pressure prevention practices improves and stabilizes, and the incidence rate has fallen to fifty percent of the baseline rate, the maintenance phase begins. The number of performance appraisals are reduced for the highest achievers each week. Performance appraisals continue at a lower rate. Higher rate of performance appraisal is triggered by an increase in incidence rate of pressure ulcers. The outcome or incidence rate of pressure ulcers drives the rate of intervention during the maintenance phase.

Keywords: pressure ulcer incidence, performance appraisal, feedback, goal setting