A Hospital Journey to Zero Hospital Acquired Pressure Ulcers

Topic – Develop and implement a hospital wide pressure ulcer reduction program. 

Purpose - This is a 410 bed tertiary inter-city hospital in Los Angeles.  At the beginning of 2007, the hospital acquired pressure ulcer (HAPU) rate was above 9%.  Nursing administration began their commitment to lower the HAPU to below the California average.

Objectives

1. Development of a hospital wide pressure ulcer prevention program (PUPP)

2. Implement interventions to prevent pressure ulcers

3. Lower the hospital acquired pressure ulcer rate to below the California state average which was under 5% at the end of 2007

Outcomes

1. In the middle of 2007, the hospital hired a CWOCN to lead the team and help in developing the program. 

2. At the end of 2007, PUPP developed, implemented and educated the staff to use the Braden scale, and developed criteria for the ordering pressure redistribution mattress, the HAPU rate dropped below 5%.

3. In 2009, the PUPP was further developed and moisture containment interventions implemented, the HAPU rate fell further below 3%.

4. In 2012, the hospital purchased hospital pressure reduction mattresses and frames. Criteria was developed in the ICU  to apply prophylactic dressings on patient’s sacrum reduced the HAPU rate to 2.1%

5. By the end of 2013, the hospital had zero HAPUs.  This was achieved by instituting prophylactic dressings on bony prominences and under medical devices for all in- patients, prophylactic dressings and pressure redistribution pads in the OR. 

6. In 2014, the HAPU rate has remained at 0% with Skin Care Champions indentified in each unit and the implementation of a Wound Care Class that provided CEU’s on correct pressure ulcer staging and prevention interventions.