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NDNQI surveys indicated continued hospital acquired pressure ulcers despite efforts to educate staff in prevention. An approach creating direct care nurse skin advocates at the unit level was identified by the organization as a method to reduce HAPU rates.
Significance:
The NDNQI quarterly surveys the last two years indicated static HAPU rates in adult critical care and neonatal units of 11%-13%. These rates were unacceptable to the organization unit nurses, patients and families.
Strategy and Implementation:
A Skin Team Advocate and Resource (S.T.A.R.) Committee was created at the Departmental level comprised of direct care nurses from each unit. S.T.A.R. members were educated on skin care, pressure ulcer prevention and device management and allowed time to meet to strategize ways of improving skin integrity. The S.T.A.R.s were mentored on the unit by the wound/skin nurse specialists and empowered to become unit based nurse advocates for skin care. Excitement grew before the NDNQI surveys and friendly competition between units to reduce HAPU rates to zero began! After the skin surveys, units with ZERO ulcers were recognized and rewarded for outstanding work on their units by a visit from the CNO and CQO. Candy in a STAR shaped dish signifies a unit with ZERO ulcers and is now highly coveted.
Evaluation:
One year after implementation of the STAR team, the aggregate HAPU rate is down to 4.3%, with zero heel ulcers and a 50% reduction in device related ulcers. More importantly nurses now look forward to the survey and getting a "ZERO" HAPU score.
Implications for Practice:
Reduction of HAPU can only occur with engagement of direct care nurses. Empower them at the unit level as skin resources and advocates through mentoring and education. To sustain success, develop a system of rewards and recognize their successes at the organizational level.