Hospital-acquired pressure ulcer (HAPU) prevention is a priority at UCSF and nursing administration and hospital-wide leadership provide strong support for this initiative. A multidisciplinary team, with members from all care settings and disciplines, is actively engaged in front-line HAPU prevention. Since 2005, we have successfully reduced our HAPU prevalence by over 70% and continue to strive to prevent all hospital-acquired pressure ulcers.
Reducing HAPUs is a Medical Center patient safety and quality organizational goal. A multidisciplinary team is actively engaged in HAPU prevention and patients and families are included as important members of the pressure ulcer prevention team. Our goal is to continually improve skin care for all patients across all inpatient settings and across the continuum of care.
Front-line Staff Lead the Way
We believe the success of reducing HAPUs begins with staff engagement. At UCSF, the Unit Skin Champions take an active role to ensure pressure ulcer (PU) prevention happens at the unit level. Each patient care unit has an identified Unit Skin Champion(s). The champion’s role is to facilitate unit level review of process and outcome data with the goal of identifying and implementing PU prevention strategies specific to their unit’s patient populations. Champions share their unit-based skin expertise on the unit when providing patient care, at monthly staff meetings and through multiple unit-based forums.
Staff education is central to our ability to provide quality patient care by fostering clinical expertise and professional development. Bi-monthly HAPU prevention classes are offered to review and continually enhance the expertise of all patient care staff. In addition, pressure ulcer prevention committee members are supported to become certified in pressure ulcer identification and staging. Knowledge is powerful and nurses at UCSF are utilizing knowledge to make powerful change in nursing patient care!
Using Innovative Technologies to Prevent Pressure Ulcers
UCSF nurses are leaders in identifying HAPU prevention opportunities and implementing innovative technologies to prevent pressure ulcers. In the intensive care units, operating rooms and the emergency and radiology departments, nurses have optimized the use of appropriate pressure redistribution surfaces. Operating room staff identify patients who are at risk for developing pressure ulcers and ensure availability of appropriate pressure redistribution surfaces during and after surgery. A nurse-created air mattress algorithm allows front-line staff to obtain an appropriate surface without delays. Nurses continuously evaluate products, specifically those related to nasogastric tube securing devices, tracheostomy equipment, peripheral IVs and oxygen saturation probes. In addition, Nursing collaborates with the UCSF School of Nursing to review the latest evidence-based literature and networks with other hospital to share best practices.
Data Transparency and Analysis
The Department of Nursing Performance Improvement provides monthly unit-level HAPU data reports to assist with identification of HAPU prevention opportunities. Data is also obtained from quarterly prevalence study days, where every patient in the hospital is examined for evidence of skin breakdown. Prevalence data is submitted for benchmarking and public reporting. Unit leadership, in collaboration with their Unit Skin Champions, facilitates front-line staff review of their data reports to initiate and evaluate improvement interventions based on data.