Getting it Right: Strategies for Implementation of a Successful Pressure Ulcer Reduction Program

Vidant Medical Center embraced the Institute of Healthcare Improvement's goal of zero events of preventable harm. Despite efforts, the organization failed to meet organizational targets and continued to struggle with hospital acquired pressure ulcer (HAPU) reduction. In 2012, the pressure ulcer program infrastructure was revised. The Pressure Ulcer Task Force was restructured to include front line staff, interdisciplinary team members and Patient Family Advisors. Pressure ulcer prevention guidelines were modified using best practice, with changes incorporated into the EHR. A new HAPU verification process was implemented. HAPU data was carefully analyzed in control and Pareto charts and utilized to drive change. Front line staff, patients and families were engaged in the development of creative tools, including Patient/Family HAPU Prevention education, HAPU Stickman, HAPU Poster, "Patient Wanted" Poster and wound photography. Innovative strategies were incorporated into unit tests of change to reduce HAPUs related to oxygen tubing, pulse oximetry, endotracheal tubes and non-invasive ventilation masks, which accounted for 62.5% of device related HAPUs. Successful strategies were incorporated into best practice and EHR and spread across the organization. Skin products/supplies were evaluated and multiple unit and/or system wide trials were implemented. Unit rounding was conducted by the skin and wound team on the five high risk units with unit leadership, staff and interdisciplinary team members to audit compliance and reinforce education. Real-time bedside process mapping was developed and conducted within 24 hours of HAPU verification, involving skin and wound, unit leadership, bedside staff, interdisciplinary team members, patient and families, to identify variables leading to HAPU development and action planing to reduce future incidence. Statistically significant outcomes were demonstrated in FY13, including a 44% reduction in prevalence rates, 25% reduction in device-related HAPUs, 12% increase in skin bundle compliance and 2.4 million dollar cost savings. Process controls were utilized to sustain successful HAPU reduction strategies.