Capturing Data and Promoting Accountability to Reduce Hospital Acquired Pressure Ulcers (HAPUs)

Purpose: To achieve zero HAPU incidence rates within a 60 bed acute care facility. In 2008, the Agency for Healthcare Research & Quality (AHRQ) estimated that 2.5 million patients in U.S. healthcare institutions develop pressure ulcers each year, resulting in 60,000 predicted deaths. These ulcers prevent functional recovery and cause substantial pain and serious infection. According to Medicare, the average cost of treating a pressure ulcer in an acute care hospital is approximately $43,000/stay with an annual cost of $9-$11 billion. 

Objective:The aim was to ascertain if documented HAPUs were in fact true HAPUs or if they were reported or captured in error. The daily skin report allowed scrutiny of documentation which revealed that 43.33% of all HAPUs reviewed were reported or captured in error. Additionally, community acquired pressure ulcers (CAPUs) not captured on admission were causing erroneous HAPUs and there was confusion between data templates and nursing documentation.

Outcome: The implementation of a daily skin report brought current data to the bedside and created a sense of accountability. Nursing documentation was redesigned to provide a seamless link with the correct data template. Education on pressure ulcer etiology, understanding of wound care product utilization and requiring dual ulcer assessments maximized assessment skills and ensured accurate documentation. Nurses were provided a product ‘cheat sheet’ to assist with selection and usage of wound care products. After 14 months of implementing the identified interventions, the HAPU incidence rate fell from 3.44 in March, 2011 to 0.83 in May, 2012 with four consecutive months of zero HAPUs from February through May, 2012. Achieving a zero HAPU incidence rate is attainable by using strategic planning and implementing a continuous performance improvement program.