Keep it Short! 5 Minute In-services Reduce Cases of Critical Care HAPU

Marianne Banas, MSN, RN, CCTN CWCN, University of Chicago Medical Center, ICU / Senior Skin Care Team Member, Chicago, IL, Jennifer Sala, ADN, RN, University of Chicago Medical Center, Critical Care RN / Senior Skin Care Team Member, Chicago, IL and Susan Solmos, MSN, RN CWCN, Center for Nursing Professional Practice and Research, University of Chicago Medicine, Chicago, IL

To decrease Hospital Acquired Pressure Ulcers (HAPU) in critically ill adult patients.


Patients with HAPU have poor outcomes such as pain, infection and almost 80,000 in-hospital deaths each year.  At an academic medical center, traditional approaches to introducing new information and practice prompts for nursing staff included posters, emails and in-services. However, it was unclear whether posters or emails were reaching all nursing staff and in-services of up to 30 minutes were resource intensive.


Developed strategy of brief targeted in-services to reinfuse knowledge related to HAPU Prevention Bundle (evidence-based (EB) prevention interventions) or create awareness of key issues in advance of EB practice changes.  

Beginning in Q4 FY15, two ICU staff nurse/members of the Senior Skin Care Team provided 5 minute in-services twice per month. Content focused on key clinical issues identified during HAPU event analyses, Skin Care Team feedback, or direct observation by the CWCN. Posters and handouts were used to reinforce the key messages of the 5 minute in-services. Topics included: appropriate placement of silicone sacral dressing, use of heel boots, medical device pressure ulcer (MDRPU) awareness campaign, and interventions to prevent most frequent MDRPU. Some topics were repeated more than once during the intervention period. The number of HAPU cases was tracked 8 months pre-and post-implementation of 5 minute in-services strategy.


By investing in 8 hours per month of senior skin care team member time, a 53% decrease in number of adult critical care HAPU cases post-implementation has been noted from 30 to 14.  


Peer to peer teaching was a successful approach and 5 minute in-services are an effective way to reach staff during their shift. Based on the success of this initiative, this strategy should be included as part of the HAPU Prevention Bundle to reinfuse knowledge and build EBP.