Embedding a pressure ulcer prevention program on an orthopedic unit

Pressure Ulcer prevention has become paramount across the landscape of acute care since the advent of CMS guidelines in 2008. This has proposed a challenge for hospitals to eliminate hospital acquired pressure ulcers (HAPU). Pressure ulcer prevention protocols have been developed by various national organizations. These protocols rely heavily on the caregiver’s knowledge base. A small  community hospital made a decision to change their data collection from monthly prevalence to daily incidence. The change in data collection showed the oorthopedic unit had a high incident rate and zero prevalence rate. An action plan was requested from administration to decrease HAPU's on this unit. After performing a drilldown the fractured hip patients were identified as a high risk group. The WOC nurse partnered with the  nurse manager/coordinator and engaged the dermal champions to develop a prevention program.

Developing a wound prevention program requires identification of staff’s baseline knowledge. To find the missing link and bridge the gap, it was imperative to observe current prevention practice and pressure ulcer prevention bundle compliance. The dermal champions were key players in communicating these findings to the WOC nurse.

Administrative support and encouragement were crucial for successful implementation of the program. All staff, RNs, patient care technicians, as well as unit secretaries were educated on the hospital’s pressure ulcer prevention bundle with specific detail given to their orthopedic unit. Protocols were refined to correspond with the specific needs of the orthopedic patient population.

A plan of care was developed for the fractured hip patient starting in the ED. Initiation of early intervention has rendered positive results.

After implementation of an individualized pressure ulcer prevention program we had an 85% decrease in hospital acquired pressure ulcers.