Using an Innovative "Safety Cross" Tool to Communicate Pressure Ulcer Risk

Pressure ulcers (PrUs) are a major health care concern in the United States affecting approximately 3 million adults annually. The Centers for Medicare and Medicaid Services (CMS) added prevention of hospital acquired pressure ulcers (HAPUs) to the National Patient Safety Initiative and have classified HAPUs as non-reimbursable. The Sixth Annual Health Grades Patient Safety in American Hospitals Study in 2009 of approximately 5000 hospitals from 2005 to 2007 found an increase in PrU incidence of 7.8% over the course of the study, resulting in a cost of approximately $2.41 billion.

The Safety Cross Tool is an innovative approach used to track patients admitted with PrUs or who develop HAPUs that may aid in influencing care outcomes. The visual tool is a modified version of the international NHS Scotland Safety Cross that represents one calendar month with daily entry data points. Each day, the number of new patients admitted with an existing PrU and any inpatients who have developed a HAPU is documented. At the end of each month, a cumulative total is reported including a Root Cause Analysis (RCA) of each HAPU.

A sixty day pilot was conducted using a convenience sample of 321 patients admitted to a 29 bed adult medical inpatient hospital unit. Findings revealed sixteen patients were admitted with an existing PrU.  In addition, nine patients were identified as developing a HAPU during their hospitalization. RCA revealed that five of these nine inpatients had PrUs present on admission, but initial documentation was incomplete or missing. Therefore, the final analysis yielded a HAPU incidence of 1.2 %.  

Application of a user friendly visual tool such as The Safety Cross can assist nurses and the interprofessional team to communicate PrU risk and facilitate implementation of evidence-based prevention and treatment measures to improve quality outcomes and reduce costs.