Preventing Pressure Ulcers in a Progressive Care Unit: CNA and RN Partnership

Background.  In 2012, our pressure ulcer incidence rate was 0.5%.  Of the hospital acquired pressure ulcers (HAPUs), 22% were associated with the Progressive Care Unit inpatient stays.  January to May 2013, our incidence rate was 0.6%.  16% of the HAPUs were associated with the PCU inpatient stays. We began an initiative to decrease HAPUs in our clinical setting. Methods.  Targeted education occurred with our Certified Nurse Assistants (CNAs). This included a 30 minute educational seminar that included the review of the Braden Scale and the pressure ulcer prevention measures.  The unit manager then initiated the Pressure Ulcer Prevention Protocol (PUPP) in the PCU.  Patients with a Braden Score of 18 or less were considered at risk. The protocol was implemented on every shift, having the CNAs complete a checklist that consisted of: 1) checking and ensuring repositioning occured every two hours; 2) ensuring soft nasal cannula were in place; 3) floating heels with the appropriate device; 4) applying preventive sacral foam dressing or use of barrier cream for incontinent patients; 5) utilization of bed decision guide for appropriate mattress; 6) utilization of pressure redistribution chair pads; 7) utilization of nutritional supplementation; 8) inspection for no objects beneath patients, inspecting under medical devices, and ensuring that appropriate linens and liners were used with mattresses; 9) examining and maintaining that patients’ skin was clean and dry. The CNAs collaborated with the floor RNs and the CWOCNs on the PUPP.  At the end of each shift, the CNAs submitted their checklist to the charge nurse who performed a subsequent review. Results.  The implementation of the PUPP and the CNAs’ engagement in pressure ulcer prevention increased awareness and a sense of accountability among staff in addition to reducing HAPUs. From June to September 2013, the PCU recorded zero incidences of HAPUs.