Implementing a Pressure Ulcer Prevention Program In a Military Treatment Facility on the Remote Pacific Island of Guam

Objective:  Describe the process for establishing an Evidence-Based Pressure Ulcer Prevention Program in a Military Treatment Facility (MTF) on the Tiny Remote Pacific Island of Guam.

In December 2009 the Director of Nursing Services approached the Nursing Clinical Practice Committee regarding the prevention of debilitating pressure ulcers on critically ill patients in the hospital's Intensive Care Unit (ICU).  The concern arose because a patient developed a Stage-IV pressure ulcer; the patient was a victim of a severe neurological insult, was ventilated, and presented with various co-morbidities; as such the patient was very vulnerable to pressure ulcer development.  However, it was apparent that organizational culture was not focused on prevention strategies and needed to be changed.  After a careful analysis of the case it was discovered that there were no established Evidence Based Prevention and Treatment Protocols available to guide nursing interventions that could reduce pressure ulcer incidence.  The resultant effect led to a vigorous review the literature, collaboration with other Military Treatment Facilities (MTF), and the subsequent establishment of a Pressure Ulcer Prevention Program (PUPP). 

The NH Guam PUPP is based on five pillars and was established in six phases.  The five pillars are: 1) Prevention; 2) Treatment; 3) Documentation; 4) Quality Management; 5) Education.  Phases of program development included:  1) Review of the literature; 2) Collaboration with other Federal agencies for best practices; 3) Establishment of WOCN educated Wound Care Nurses; 4) Staff education at levels of the organization; 5) Establishing Risk Management metrics to monitor program effectiveness; 6) Organizational implementation

Results:

NH Guam has an effective Evidence Based PUPP that is incorporated into Admission, Inpatient Treatment Regimens, and Discharge Planning.  Pressure Ulcer reduction strategies are also discussed during bi-weekly interdisciplinary Discharge Planning Sessions.