Expansion of PUPP Bundle Required to Sustain Pressure Ulcer Reduction across Acute Care Units

On the Cardiopulmonary and Intermediate Care units, there was a 50-60% increase in pressure ulcer incidence from January to May of 2014 over that same time frame in 2013. Our first response to the increase was to reeducate staff at the hospital-wide skin fair. This resulted in a reduction of pressure ulcers, but only for a short time. Next, we revised our PUPP Bundle. Our Pressure Ulcer bundle now includes: daily rounds with the charge nurses of both units, WOC nurse attendance at staff huddles, reporting on any hospital acquired pressure ulcers at leadership huddles, completing an A3 ( Root Cause Analysis) after any pressure ulcer is identified, leadership rounds on both units to increase staff awareness ,re education of the use of a prophylactic silicone 5 layer sacral dressing in the Intermediate Care unit, expanded use of a prophylactic silicone 5 layer dressing on the Cardiopulmonary unit and introduction of a prophylactic silicone 5 layer heel dressing on both the Cardiopulmonary and Intermediate Care units. The 2014 NPUAP/EPUAP guidelines recommend the use of foam dressings to aid in the prevention of pressure ulcers. We utilized the sacral dressing supported by 2 recent randomized controlled trials. The layers in these dressings move independently to reduce shear and friction while helping reduce pressure. Wicking of moisture within the dressing helps balance microclimate.

Results: As of December 2014, we achieved a 100% reduction in pressure ulcer incidence in the Intermediate Care and Cardiopulmonary Units by revamping our PU Bundle.

Conclusion: Prophylactic dressings along, with renewed education, increased staff awareness and leadership initiatives, are key interventions to sustain PU incidence reductions in intermediate risk environments.