Quality Improvement at a Medical Center

This  Study took place within a 234 bed community acute care hospital, who had been struggling with an increase in the number of hospital acquired pressure ulcers. The wound care nurses saw an opportunity for a quality improvement initiative. Thus, they developed the following comprehensive prevention protocol.

The purpose of this study was to decrease the incidence of pressure ulcers at the facility. The unique variable was the implementation of prevention strategies at the point of entry...the Emergency Room.

The method utilized was the development of a prevention protocol that was launched in August of 2008 and continues today. The protocol begins in the Emergency Room, at which point a Braden Scale is done on every patient upon arrival and then daily. Patients that score a 15 or less are placed on the protocol. The protocol encompasses multiple interventions. Each patient receives a static air mattress overlay as well as a static air cushion. All patients wear a bracelet identifying them as on the protocol. All staff were educated on prevention strategies as well as staging. They were given rulers with staging guidelines highlighted on the back. They utilize body diagram pads as a tool to document pressure ulcers.

The data is collected continually in the ER and throughout the hospital. The data shows a remarkable 95-100 % compliance rate with completing the Braden on all ER patients as well as initiating the protocol on all appropriate patients.

The data prior to initiating the protocol in 2008 reflected a combined Community Acquired Pressure Ulcer and Hospital Acquired rate of 4 -7 percent. Since the implementation, the combined Pressure Ulcer rate has been under 1 percent. The facility also notes zero Stage III Hospital Acquired Pressure Ulcers since February of 2010.