Zero Out Hospital Acquired Pressure Ulcers

Hospital acquired pressure ulcers (HAPUs) are a primary indicator of the quality of nursing care provided in hospitals. In 2010 our hospital had an overall HAPU rate of 4.07 %. The hospital established a goal to decrease HAPU’s to below the national benchmark of 2.5 %. In addition to decreasing the HAPU rate, our objectives were to establish measures to increase staff awareness and knowledge of effective interventions and documentation for reducing HAPUs. Evaluation of this problem revealed that a multi-pronged approach was needed to saturate and sustain practice change. A key practice change was developing weekly skin care rounds to bring the issue to the bedside. In order to set the stage for this practice innovation, groundwork was done to ensure that the staff were educated in the latest practice, understood the documentation that was expected, and understood the goal in mind. The project called “Wounds on Wednesdays” (WOW) was started May 2011, targeting the units with the highest HAPU rates. These rounds consisted of a team evaluating all patients with a head to toe skin assessment, chart audits for documentation, product usage, and risk assessments on all patients. The survey teams consisted of an RN and PCA, with the unit’s Skin Champion as the coordinator.  WOW rounds were initially done weekly with immediate feedback to staff with the help of electronic data collection.  As HAPU results improved, WOW rounds decreased to bimonthly, and then monthly. WOW rounds revealed additional issues and solutions were implemented throughout the hospital.  The HAPU prevalence rate decreased from 4.07% before WOW rounds to 3.41% immediate post rounds.  It continued to decrease below national benchmark in 2011 at 1.42%.  The most recent prevalence in November 2012 was 0%.  Improvement has also been seen in the use of effective interventions and documentation for reducing HAPUs.