Process Improvement Leadership Program to Decrease the Incidence of Hospital Acquired Pressure Ulcers in the ICU/CSU

Wound and Ostomy nursing practice is changing at a rapid pace and it's important to focus on continuous quality improvement as a part of providing care every day. The Process Improvement Leadership Program (CPIP) purpose is the engagement of clinical teams in the use of process improvement tools to reduce variation in care and improve outcomes for patients.  This is a fast-paced, immersion program that gives participants the tools they need to evaluate and improve a process at their own institution, within the span of four months. Our group used techniques like performing root cause analyses, interviewing frontline staff, and creating process maps and cause and effect diagrams. Our project focused on the prevention of Hospital Acquired Pressure Ulcers in the ICU and CSU. The team of doctors, nurses, PA’s, a nutritionist, and administration focused on recognizing the increased risk of ICU and CSU patients for the development of HAPUs. The group came up with the factors that contribute to PU development in the ICU. They also created process maps, cause and effect diagrams, and performed structured interviews/surveys with ICU and CSU staff nurses. They reviewed three months of patient care charts to get a better sense of what was actually included in the nursing assessment for risk of impaired skin integrity. A theme of variability in the skin assessment, inconsistency with the Braden scale interpretation and variations in skin protocol use was noted.

Through this project, the team created a baseline process map to trigger nurses of the protocols to put in place for the high risk ICU patient. The advantage of this approach is the quickly developed plan and the support of a multidisciplinary team at the hospital building on improving quality for patients and asking the questions about avoiding hospital acquired pressure ulcers.