The Pressure Is ON.....to Keep the Pressure OFF

Background

Pressure ulcers (PU) are harmful to patients, expensive and effect healthcare reimbursement. 

Annually in the United States, over 2.5 million people develop PU at an estimated cost of $11 billion¹.  Single pressure ulcer treatment can cost $70,000, and 60,000 die of pressure ulcers complications¹.

Strategy

The project goal was to decrease Hospital Acquired Pressure Ulcers (HAPUs) at a 600 bed academic level one trauma hospital located in Southern US by implementing proven evidenced based reduction practices.

Practice Change

Interventions on Med/Surg and ICU included:

• Educated on: skin assessment, risk assessment (Braden), incontinence care, heel elevation, repositioning, and nutrition^6,7,8
• Placed turn clocks in Med/Surg rooms⁴
• Applied preventative foam dressings to sacral area during lengthy surgeries²
• Initiated improved skin care products⁶
• Implemented hourly rounding to include patient repositioning³
• Purchased new pressure redistribution support surfaces⁶
• Increased the number of nutritional and dietary consults

Evaluation

HAPU rates have been tracked quarterly with the National Database of Nursing Quality Indicators⁵ (NDNQI) and monthly per 1000 patient days (PD). In 2Q11, the NDNQI data showed that 3.59% of our Med/Surg patients and 30% of our ICU patients had Stage II or greater PU which was above the national mean. In October 2012, combined rates for ICU and Med/Surg were 1.7 per 1000 PD. 

Results

Overall, PU rates and staff awareness has improved. For the Med/Surg units, we were below the NDNQI mean 10/14 quarters with the last ten consecutive quarters being below the mean.  Our ICU was below the NDNQI mean 8/14 quarters.

From Oct 2012 through November 2014, the ICU and Med/Surg combined PU rate per 1000 PD was below the Ascension benchmark (0.86) for 19/26 months⁹.  The lowest rate was 0.0 per 1000 PD.

Conclusion

Hard-wiring the interventions and keeping this on the forefront of nurses minds is a priority.