1553 Reduction of HAPU to heels and the high risk hip fx patient using a Transformational Care (TC) Model

Luisa Kelly, RN, MS, CWOCN, Dominican Hospital, Dignity Health, Wound/Ostomy Nurse, Santa Cruz, CA
The HAPU Reduction Interdisciplinary Team set a goal of attaining at least a 25% reduction in heel pressure ulcers for FY 2012 vs. FY 2011. The Transformational Care (TC) Model was used to define the problem specifically as “Why are patients getting hospital acquired heel pressure ulcers?”.  The scope of the problem was determined with the highest incidence occurring on the orthopedic and cardiac floors, and hip fracture patients identified as being the highest risk population. Potential barriers were also recognized including articulation of the process and accountability from staff and patients to comply/initiate care and prevention strategies.  Stakeholders in this process were listed.  The context of the problem was also reviewed.  A process map was developed that tracked the flow of a patient with a hip fracture from the emergency room to the nursing unit directly, or to the OR and then a nursing unit.   Issues were prioritized based on frequency of occurrence, and impact of occurrence.  Problem solving by each issue was addressed with key stakeholders.  Key actions were then developed with a time frame and owner of each action assigned. Key actions included: the use of a soft silicone heel dressing placed in the ER to the affected heel; increase purchase of heel offloading devices to the nursing units; revision of post –op orders to decrease ted hose use; traction boots in the OR were reviewed by the manufacture to make sure liners were not faulty; the CWOCN making daily M-F rounds on all admitted hip fx patients to ensure prevention strategies including patient/family education are completed.   Key metrics were established including FY 2011 heel HAPU numbers (17) and post TC model interventions FY 2012 heel HAPU numbers (7).  The team’s goal was a 25% reduction; the team achieved a 41% reduction.