Joyce Stoelting, RN-C, ADN, CWS, Memorial Medical Center, Clinical Nurse IV, staff nurse and member of Memorial Ostomy & Wound Services, Springfield, IL, David Neff, CLSSBB, Memorial Medical Center, Operations Improvement Project Leader, Springfield, IL, Donna Redding, RN, PhD, NE-BC, Memorial Medical Center, Director, Nursing Outcomes Improvement, Springfield, IL, Tina Weitzel, MA, RN-BC, Memorial Medical Center, Nursing Practice Development Facilitator, Springfield, IL, Linda McKenna, RN, BSN, CWOCN, Memorial Medical Center, Clinical Nurse IV, Member of Memorial Ostomy & Wound Services, Springfield, IL, Elizabeth Taggart, RN, BSN, CWOCN, Memorial Medical Center, Clinical Nurse III, Member of Memorial Ostomy & Wound Services, Springfield, IL, Katie Hortsmeyer, RD, LDN, Memorial Medical Center, Registered Dietitian, Springfield, IL and Geri Kirkbride, RN, MSN, PhD(c), Memorial Medical Center, Research Nurse Facilitator, Springfield, IL
Problem and Purpose:Despite implementation of evidence-based Pressure Ulcer Prevention (PUP) protocols, an estimated 7% of hospitalized patients continue to acquire these painful and debilitating injuries (Armstrong, 2008). Improved outcomes have been shown with initiatives using evidence-based bundles, focused education, and systematic surveillance (Jankowski, 2011). Limited evaluations of bedside practices, lack of involvement of all members of the health care team, poor communication of at-risk status, and limited staff education and training contribute to poor PUP outcomes (Jankowski, 2011). This evidence-based practice project sought to reduce the prevalence of hospital acquired pressure ulcers by standardizing pressure ulcer prevention (PUP) practices.
Framework and Design:Lean Six Sigma (LSS) quality management methods were used to identify practice variances and to standardize existing PUP approaches. Project oversight was led by a LSS Black Belt and multidisciplinary team. Defined and sequenced steps were used to identify defects in local practice, such as identifying at-risk patients, individualizing PUP interventions, and achieving minimal turning requirements.
Implementation:Two pilot units tested and evaluated improvement strategies. The PUP program was updated and interventions were organized into a “Pressure Ulcer Prevention Bundle.” Expectations, such as standardized times and a team approach to turning were established. The electronic documentation system was also updated to support improvements such as the dietary consult. Improvements included such things as bedside communication tools, turning reminders, a dietary consultation trigger, and enhanced patient/family education. A resource binder containing practice expectations and unit level performance guided staff education via Unit Based Council Meetings and individual communications. Weekly rounding provided opportunities to address staff questions and identify potential implementation barriers.
Results/Implications: Two months after initiating the pilots, these units achieved fewer defects in care practices. Recent surveillance indicates zero pressure ulcer prevalence rates across each unit. This project is undergoing evaluation.
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