Implementation of a Successful Pressure Ulcer Prevention (PUP) Program in a Tertiary Care Hospital

Introduction:

In 2008, CMS decided to stop all reimbursement for stage III and IV Hospital Acquired Pressure Ulcers (HAPU). We describe our experience at the Minneapolis VAMC, where we implemented innovative means to address HAPU. The Interdisciplinary Pressure Ulcer Prevention Committee (IPUPC) was created to evaluate, recommend, and implement changes in the hospital. The aim of our study is to provide a working format for hospital administrators interested in reducing HAPU.

 

Methods and Materials:

We initiated an ‘Analysis’, ‘Design’, ‘Implementation’, and ‘Maintenance’ Cycle in 2009, and data on HAPU was collected.

Results:

The IPUPC decided to ‘Implement’ the following changes:

1)   A hard-stop to document at the time of admission the presence or absence of a pressure sore

2)   A concerted effort to educate all the providers of the hospital on the steps to prevent HAPU and our ‘new’ protocols.  

3)    We created ‘Skin Champions’ on every floor (nurses who were ‘experts’ at PUP). They conducted regular PUP rounds, and were responsible for collecting data on HAPU.

4)   On admission and then at daily rounds, every patient ‘flagged’ at risk for a potential HPAU had a specific ‘PUP’ order set placed.

5)   HAPU identified on daily rounds would initiate an ‘Incident Report’ that would have to be followed up by the appropriate nurse manager.

6)   Implementation of quarterly data collection rounds: Every 3 months the WOC nurses and Skin Champions would examine EVERY patient on EVERY floor for HAPU (Prevalence-Incidence (PI) Studies).

Once the above steps were initiated, at the monthly IPUPC meetings every HAPU would be discussed in detail and a RCA (Root Cause Analysis) performed. This became part of our ‘Maintenance’ Phase. Through these RCA and quarterly PI studies, we made continuous improvements and updates in the protocols for PUP.

The above steps resulted in a 78.4% drop in total HAPU in 3 years, with an 82% drop in Stage I and II HPAU, and 50% drop in Stage III and IV HAPU.

Conclusions:

A multi-disciplinary team implemented the ‘Analysis’, ‘Design’, ‘Implementation’, and ‘Maintenance’ Cycle to successfully change culture and drop HAPU by about 80% in 3 years. This approach can be used by other tertiary care centers to improve pressure ulcer prevention outcomes.