This power point goes over how an organization can implement and sustain a hospital wide pressure ulcer prevention program using current evidence-based practice.

1. GBMC Pressure Ulcer
Prevention Program
Marie Barry
Masters in Leadership/Management
Candidate
Stevenson University

2. Objectives of a Pressure Ulcer
Prevention Program
► State why a pressure ulcer prevention is important
► Understand how GBMC can initiate and sustain a
pressure ulcer prevention program hospital wide
► Identify best practice in order to diminish the
prevalence of hospital acquired pressure ulcers
► Identify strategies to overcome organizational
obstacles
► Learn how to disseminate new learning
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3. Why is pressure ulcer prevention
important?
► Pressure ulcers are preventable
► Pressure ulcer occurrence is a quality care
indicator
► Diminishes a person’s quality of life
► Increases a patient’s length of stay
► Reflects negatively on a healthcare organization
► Creates organizational financial hardship
► Prevention is listed as part of The Joint
Commission’s National Patient Safety Goals
3

4. Pressure Ulcers listed by Medicare in
2007 as a “never event”
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5. Factors that contribute to the
development of hospital-acquired
pressure ulcers:
► Advanced age
► Inadequate patient mobility
► Severity of illness
► Chronic medical conditions
► Incontinence
► Pain
► Malnutrition
► Cognitive decline
► SICU, MICU, ICU patients 5

6. Clinical areas with high
pressure ulcer prevalence
► ED-patients may wait up to four hours
before being placed in a hospital bed
► ICU-life saving equipment limits mobility
► Critical care settings
► PACU
► Orthopedic unit
► Geriatric unit
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7. Diligent nursing care can prevent
nearly 100% of hospital-acquired
pressure ulcers
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8. Financial impacts
► Rising prevalence over last 10 years
► Rising healthcare costs
► Hospital acquired pressure ulcers will no longer
be reimbursed by Medicare and Medicaid
► Increases length of hospital stay
► Adds avoidable costs to the healthcare
organization
► Leads to increased litigation
► Pressure ulcer occurrences may negatively
impact future patient referrals 8

9. Potential Organizational
Cost Savings
► For each individual healthcare organization,
between $3 million and $ 4 million a year in
unreimbursed medical expenses
► Investment in pressure redistribution
mattresses had a ROI within 6 months
► Expensive litigation
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10. How can GBMC initiate a Pressure
Ulcer Prevention Program?
10

11. Assess GBMC readiness for the
implementation of PUP
► Organizational change requires a system- wide
approach
► Determine the level of the leadership commitment
► Recognize barriers to change: workflow,
communication, change in practice, time
► Form small focus groups
► Interdepartmental surveys
► Use toolkit readiness checklist
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12. Strategies to solidify readiness for a
hospital-wide PUP program
► Pilot a PUP on a high risk unit
 Demonstrate program success in order to obtain
staff support
 Collect and disseminate data of pressure ulcer
prevalence
 Determine individuals interested in becoming
unit-based champions
 Hospital-wide awareness campaigns (posters,
screen savers, town hall meetings, staff
meetings) 12

13. Strategies to overcome
organizational obstacles
► Determine successful processes already in place
► Explain to staff the importance of program
implementation (Federal and State mandates)
► Create urgency to key stakeholders (financial and
clinical benefits)
► Provide leadership and support
► Provide financial and supportive resources
► Listen to staff
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14. Best practice to eradicate
pressure ulcers
► Identify patients who are high risk by using the
Braden scale & reassess every 12 hours
► Early intervention
► Relieve pressure, reduce moisture
► Reposition every 2 hours
► Digital cameras to assist with documentation
► Hourly rounding to identify patient care needs
► Educate interdepartmental key stakeholders on the
importance of a pressure ulcer prevention program
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15. Best practice to eradicate
pressure ulcers
► Educate staff, patients, and families
► Assess skin integrity within four hours of
admission to ED
► Develop a daily skin care flow sheet
► Initiate a physician driven order set for high risk
patients
► Interdepartmental collaboration
► Utilize patient identifiers for high risk patients
► Revise policies and guidelines every 2 years and as
needed
► Wound care resource books on each unit
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16. Measure pressure ulcer rates
► Determine unit pressure ulcer rates for the last 12
months
► Identify units that require immediate intervention
► Use CMS guidelines to create policies and
protocols
► Acknowledge adverse events
► Acknowledge legal action within the organization
► Perform a root-cause analysis with each
documented hospital-acquired pressure ulcer
► Voluntary report to governmental agencies
► Quarterly pressure ulcer prevalence studies
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17. Education and communication
► Pre-shiftreports
► Nurse-to-nurse reports
► Interdepartmental reports
(ED, OR, PACU, HD,
Out-patient services)
► Unit-based wound/ostomy resource book
► Pressure ulcer prevention champions/teams
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18. Education and communication
► Simulationlab for competencies and new
nurse orientation
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19. Don’t reinvent the wheel
► Inter-facility
collaboration
► Learn from their success and mistakes
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20. OSF St. Francis Medical Center in
Peoria, IL
► SOS campaign-SAVE OUR SKIN
► Every two hours, Olympic-style theme music
is piped over the audio system to remind
staff it is time to reposition patients
► Nurses and techs receive a page every two
hours: “Please turn your patients now.”
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21. Genesis Medical Center in
Davenport, LA
► “TOE”: Turn, Overlay, Elevate
► Turn the patient for prevention
► Overlay beds/chairs with specials surfaces
► Elevate bony prominences and heels
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22. Owensboro Medical Health System in
Kentucky
► “Four-eyed body check” on admission
► Two nurses check the patient head to toe Q 24 hr
► Patients can refuse which is documented in the
medical record
► Wound rounds bi-weekly
► Identify key people within the organization
► Be consistent
► Track outcomes
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23. Pennsylvania hospitals introduced a
color of safety
► Color-coded wristbands communicate level
of patient’s risk
► Place a patient identifier outside of the
patients door
► Use color-coded stickers on patients charts
► Be consistent
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24. Color of Safety
Communicate and Educate
► Initiate
wristbands upon admission or
changes in medical condition
► Educate patients, staff, and family regarding
the purpose of wristbands
► Coordinate signage: doors, chart, stickers to
match wristband color
► Wristband education to facilitate inter-
departmental and inter-facility
communication
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25. Staff reminders
► Place
a clock with moveable hands as a staff
reminder to turn patients
► Soundsystem or chimes to indicate turning
► Automatic pager timers to direct care staff
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26. Documentation
► Important in order to comply with state and
governmental standards
► To ensure quality patient care
► Be consistent
► Use available technology
► Photographic documentation
► Key to the defense of legal action
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27. Resources necessary for
implementation
► Ensure adequate resources:
 Non-clinical time for staff team meetings
 Training and education of staff
 Leadership time to monitor and support teams
 Product and bed product education
 Adequate staff coverage for staff education
 Funds for printed materials
 Information technology changes -- documentation in
electronic patient record
 Performance Improvement -- data system to accurately
reflect pressure ulcer prevalence
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28. Interdisciplinary teams are key to
PUP success
► Teams need a strong link with leadership
► Teams can generate enthusiastic and
capable leaders with defined unit-based
roles
► Responsible for reporting performance
improvement data and monitoring unit
specific process
► Will be responsible for bringing evidence-
based best practice to the bedside 28

29. Representatives on the PUP team
► Staff nurses
► Risk managers
► Nursing assistants
► Registered dietitians
► Unit managers
► Unit secretary
► Physicians
► PT/OT
► Wound care nurses
► Materials manager
► IT department
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30. Create a program to
disseminate learning
► Wound care team will be the primary resource for
staff, patients and families
► Unit-based team members will perform skin and
pressure ulcer risk assessments
► The interdisciplinary team will work with staff and
leadership to develop and implement a PUP
program
► Physician champions will educate residents
► Use hospital-side identifiers for persons who are at
high risk for developing pressure ulcers 30

31. Pressure ulcer prevention
sustainability
► Wound care nurses and unit champions will
be responsible for maintaining best practice
► Unit based teams will be expert resources
► Continued leadership support
► New employee orientation
► Yearly competency
► Unit-based PI studies
► Posters
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32. A pressure ulcer prevention program
requires a team in order to achieve
success and sustainability
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