Increasing Quality Measures Across Network: Utilizing a BED Algorithm

The purpose of this project was to utilize the evidenced–based bed algorithm of a teaching hospital with zero hospital acquired pressure ulcers (HAPU) into a larger hospital.  An increase in litigation regarding HAPU was noted by the Corporate Quality department.  Success of a teaching hospital’s HAPU rate from 6% to 0% was recognized.  The Corporate Quality department inquired within about possible educational opportunities for the staff to help them identify risk factors for HAPU’s in order to improve their outcomes.

The objectives of this project were to conduct chart reviews and identify underlying factors.  An interesting chain of events where found.  The first area of concern was that many nurses score the patient too high on the Braden Scale and therefore did not initiate the Pressure Ulcer Prevention (PUP) Protocol, including using the bed algorithm for a support surface, turning the patient, and documenting the care given.

The second area was that nurses were not doing a thorough skin assessment and patient interview. The third was lack of documentation.  Lastly, the chart did not include a photograph of the skin on admission that displayed abnormal findings.  This includes non-blanchable erythema, partial and full thickness wounds, and Incontinent Associated Dermatitis.

The project was conducted in a 300 acute care bed hospital.  Historical rates of incidence of HAPU were 2.6-3.3%. The education given stemmed from Corporate Quality department’s initiatives.  It was then passed to Educators and Clinical Nurse Leaders.  The PUP protocol included the use of the unit based algorithm, proper Braden scoring, implementing PUP, assessment of skin, photographing abnormalities and proper support surface selection. The efficacy of the bed algorithm will be determined in the next Prevalence and Incidence.  A significant decrease in HAPU is expected.