PR14-008 The Use of 1-4-8 Rule to Decrease Pressure Ulcers

Ashlee Beaner, RN, BSN, CWOCN, Vivian Pacheco, MS, RN, CRRN, CWOCN, Jon Killingsworth, RN, BSN, CWOCN, Ellen Murrell, RN, BSN, Christine Arsenault, RN, BSN and Allison Proto, RN, BSN, Craig Hospital, Englewood, CO
Abstract Text: The Use of 1-4-8 Rule to Decrease Pressure Ulcers

As a Magnet facility, our rehabilitation hospital strives to keep hospital-acquired pressure ulcer (HAPU) rates low as a quality care indicator. Data accumulated during quarterly prevalence skin surveys revealed a trend showing pressure ulcers to heels as a common site. During the prevalence survey conducted on 11/14/12; three patients were identified with hospital acquired pressure ulcers. One of those patients presented with 2 unstageable heel ulcers and a stage I right lateral foot ulcer.The prevalence rate at that time was 3.75%, higher than the goal of <2.65% ( the new Magnet benchmark). Due to the need to increase patient safety standards the wound care department implemented new changes for 2013. Implementation of a Skin Bundle was put into effect and the skin care scholars program was developed and utilized. At this time education was reviewed showing a deficit in knowledge and materials, specifically in the subject matter of preventing foot pressure ulcers. To meet the challenge of decreasing the HAPU rate and specifically lowering feet pressure ulcers the skin care scholars created an educational poster titled Prevention: Foot Pressure Ulcers. The poster reviewed learning the causes of foot pressure ulcers, ways to offload heels while in bed, how to properly check under compression stockings, potential problems with compression stockings, and shoe education including the 1-4-8 rule. The 1-4-8 rule guides the practitioner and patient into assessing the patient’s feet at those designated times when wearing a new pair of shoes. Identification and implementation of preventative measures for those at risk for pressure ulcers is essential in the rehabilitation setting. We continue to see our hopspital acquired pressure ulcer rates decrease due to the education our patients and staff are receiving.