Making a Difference in Pressure Ulcer Prevention

Making a Difference in Pressure Ulcer Prevention

Deseret Faull, RN

Stacey S. Shelley RN, MSN, MBA-HCM

Purpose: To create a process on an inpatient surgical unit in a pediatric hospital to improve nursing compliance with the Pressure Ulcer Prevention (PUP) bundle to 90%. The impact on pressure ulcer recognition and care was measured.

Background: The location of 74% of these pressure ulcers is on the occiput, coccyx, heels, and peripheral intravenous (PIV) catheter site. In response, a PUP bundle was created. The surgical unit consistently had one of the lowest compliance rates. This rate was as low as 9.1% in September 2013.

Method: The off-going and on-coming nurses simultaneously check the occiput, coccyx, heels, and PIV skin sites at shift change as a part of the bedside hand-off process. Education was provided to the RN staff in January 2014 with a go live date of February 1, 2014. Four audit tools were used to determine compliance including: blind audits, self-auditing, peer-auditing, and two-man team audits.

Results:  After implementation of checking the four skin sites in handoff, the surgical unit achieved 90% or greater PUP bundle compliance 21 of 29 months. Patients on the surgical unit have been pressure ulcer free since August 2014. During the months of June to September 2014, the surgical unit reported 23 patients with blanchable redness on the skin.

 Conclusion: To date, the surgical unit has continued to lead the hospital in bundle compliance since implementation. The surgical unit is the only unit to implement this practice. A neuro-trauma unit will be starting implementation in October 2015. Recommendation is to implement this process hospital wide.