Overcoming Challenges in Pressure Ulcer Prevention in a Large Hospital System

Purpose/Objective: The purpose of this initiative is to describe a sustainable process for reducing pressure ulcers (PU) in the acute care patient population and to maintain consistent staff participation through a unit based skin champion network and education. Background/Significance: Reducing and maintaining the incidence of pressure ulcers according to the best practice guidelines and evidence-based practices has been shown to improve patient care outcomes. Sustaining a decrease in pressure ulcer incidence in a large public, teaching institution, through quarterly Pressure Ulcer Prevalence studies has been a significant challenge. This problem affects quality patient care as well as cost reimbursement due to hospital acquired PU. Methodology/Data Analysis: Implemented quarterly hospital-wide evaluation of the inpatient population to detect and record the incidence of PU. Through inservices, tutorials, and workshops hospital-based nursing staff and the unit-based skin champions have been educated by the Wound Ostomy Continence Nurse (WOCN) Team in conjunction with the Education and Development department. The methods used included completion of the pressure ulcer tutorial by the clinical staff nurse, weekly surveillance of the patient care units, reporting of weekly surveillance findings to the WOCN coordinator, and implementing best practice guidelines to achieve positive patient outcomes. The results of the quarterly prevalence studies are reported to the National Database of Nursing Quality Indicators (NDNQI). Findings/Implications: Some of the challenges encountered have included inconsistent practices, change in products used to prevent skin breakdown, and a lack of staff to implement prevention measures. In some cases, staffing issues have resulted in a reduction or elimination of weekly patient skin rounds. In addition, we have found to have inconsistent prevalence team members and a reduction in staff to conduct the quarterly surveys predisposing the studies to participant error in assessment and/or data collection.