Pressure Ulcer Prevention: Our Journey to Reducing Hospital Acquired Pressure Ulcers

INTRODUCTION: There is much in the literature regarding hospital acquired pressure ulcers (HAPU’s) and the strategies implemented on the journey to zero hospital acquired pressure ulcer rates. With these resources available, our organization recognized that we had an opportunity for improvement to reduce HAPU’s. 

OBJECTIVE: To build on current evidence based strategies to reduce the number of HAPU’s.

METHOD: An interdisciplinary team, including nursing leadership, the hospital acquired conditions (HAC) team, supply chain management, IT support, ancillary departments, and the CWOCN, was formed in 2013 to evaluate evidence based practice strategies.  With continuous revision, recommendations implemented include: (1) All RN’s and NA’s are assigned education modules that provide education about skin, nutrition, incontinence management, pressure ulcer prevention, support surfaces,  and pressure ulcer staging; (2) Change in skin and wound care product line; (3) Patient/Family Pressure Ulcer Education Brochure; (4) medical device related pressure ulcer reduction strategies; (5) new support surfaces; (6) new prevention heel boots; (7) two RN patient skin assessment on admission to hospital; (8)Braden score to trigger nutrition support consultation; (9)change in incontinence management strategies, and (10) information badge cards. These new strategies build on our electronic medical record (EMR) notification to providers, use of resources within the EMR to guide therapy, skin and risk assessments, and provision of notification to the CWOCN of a documented pressure ulcer.

RESULT: In 2012, there were 211 HAPU’s in our facility. In 2013, 168 HAPU’s; in 2014, 125 HAPU’s; from January to September 2015, there are 55 HAPU's. This demonstrates a continuous reduction in HAPU’s for our facility.

RECOMMENDATION: Pressure ulcer prevention requires continuous attention to and revision of evidence-based strategies to sustain a reduction in hospital acquired pressure ulcers.   An interdisciplinary team is necessary to the care of the patient, reduction of HAPU’s and the success of the organization.