The use of a comprehensive prevention program to reduce hospital-acquired pressure ulcers (HAPU)

Background. In 1992 the Agency for Healthcare Quality and Research (AHRQ) published clinical practice guidelines for the prevention of pressure ulcers (PU).  Since then, research has continued to inform additional clinical practice guidelines through various organizations, including the WOCN and the NPUAP.  While these guidelines are continually updated and provide the latest evidence on the prevention and treatment of PU, they provide far less guidance regarding the pragmatic application into everyday clinical practice.

Research supports that the implementation of a comprehensive PU prevention program can reduce the incidence and cost associated with HAPU.  Key components of successful programs include engagement of the nursing staff, good relationships among healthcare team members and maintenance of the momentum over time.

Methods. We have a comprehensive and ongoing HAPU prevention program.  Key components include: monthly wound council meetings, mandatory annual wound and skin education, mandatory CWOCN nurse consults for HAPU stage II or greater, peer-to-peer education, review of all HAPU with unit staff, documentation review, use of  evidence-based prevention protocols, full day contact hour program, weekly skin rounds in ICU, performance improvement plans, and a visible, full-time CWOCN.

Results. Quarterly point prevalence is conducted on all clinical units for HAPU.  Hospital prevalence rates were: 2013 (0.65%); 2014 (0.22%); and the first three quarters of 2015 (0.61%). Our data indicate a very low HAPU rate which we have successfully maintained for over three years. 

Conclusion.  Our experience adds to the existing clinical evidence which supports that maintaining a culture of HAPU prevention in an acute care setting is an essential part of HAPU prevention. The cost of HAPU prevention can be off-set by the cost avoidance realized from HAPU reduction. Hospitals would benefit by becoming more analytical in their approach to balancing the cost of comprehensive prevention program with savings from HAPU reduction.