Inpatient Pressure Ulcer Prevalence in an Acute Care Hospital Using Evidence-Based Practice M. Elizabeth Beal, MSN, RN, CWON • Kimberly Smith, MSN, RN, CWON
Keywords
Pressure ulcer prevention,
prevalence rate, hospital-acquired,
evidence-based practice,
acute care
ABSTRACT Background: A national goal was set in 2004 for decreasing hospital-acquired pressure ulcers (HAPUs). A mean to achieve that goal was initiated in 2005 with long-term care facilities. Acute care facilities, with encouragement from the Centers for Medicare and Medicaid Services, took action.
Aims: Pressure ulcer prevention efforts at MaineGeneral Medical Center (MGMC), a 192-bed acute care hospital in Augusta, Maine, sought to reduce HAPU prevalence from a mean of 7.8% in 2005.
Methods: A retrospective study over a 10-year period, from 2005 through 2014, tracked HAPUs and evidence-based practice (EBP) initiatives to decrease the annual mean prevalence rate.
Results: The annual mean HAPU prevalence rate of 7.8% in 2005 decreased to 1.4% in 2011, then maintaining this level through 2014 at MGMC. Evidence-based practices for pressure ulcer prevention were implemented using data collection tools from the National Database of Nursing Quality Indicators; guidelines from the National Pressure Ulcer Advisory Panel; and procedural guidance tools from the 5 Million Lives Campaign and the Agency for Healthcare Research and Quality.
Conclusions: Accurate data collection methods and evidence-based guidelines are vital to im- proving care; yet planning with annual review, fostering an EBP culture, by-in of stakeholders, and education, are the means to long-term consistent implementation of pressure ulcer prevention measures.
Linking Evidence to Action: Keys to decreasing and maintaining the rate were based on effec- tive scientific evidence for prevention of pressure ulcers: assessment tools, education, planning guidance, documentation, and evidence-based practice guidelines.
BACKGROUND The National Council on Disability Government Performance and Results Act (National Council on Disability, 2005) set a national goal to reduce long-term care facility pressure ulcer prevalence rates. The Centers for Medicare and Medicaid Ser- vices (CMS, 2004) was directed by this act to create a means to achieve that goal (Lyder & van Rijswijk, 2005). In response, the Institute for Healthcare Improvement (IHI; 2006) began the Protecting 5 Million Lives From Harm campaign, build- ing on its 100,000 Lives campaign started in 2004, to help hospitals engage in preventing pressure ulcers. In 2006, the Agency for Healthcare Research and Quality (2014) developed the Pressure Ulcer Prevention Toolkit citing the National Pres- sure Ulcer Advisory Panel (NPUAP, 2014) as a resource for pressure ulcer best practice.
Pressure ulcer prevention efforts at MaineGeneral Medi- cal Center (MGMC), a 192-bed acute care hospital in Augusta, Maine, has been successful in reducing hospital-acquired pres-
sure ulcers (HAPU) prevalence in patients from an annual mean of 7.8% in 2005, to 1.4% in 2014 (see Figure S1, avail- able with the online version of this article), using measurement tools from the National Database of Nursing Quality Indicators (NDNQI; Press Ganey Associates, 2015). HAPUs are any stage of pressure ulcer assessed on a patient after 24 hours of being in the hospital that was not documented upon admission. This ar- ticle will discuss the successful process used by MGMC to reach and maintain the decrease in annual mean hospital-acquired pressure ulcer prevalence rate through evidence-based prac- tices (EBP).
AIMS AND METHODS This is a retrospective study addressing the impact of various implementations to decrease hospital-acquired pressure ulcers (see Figure S2, available with the online version of this article). Over the 10 years included in this discussion the same certified wound, ostomy nurse (CWON) directed the implementations.
112 Worldviews on Evidence-Based Nursing, 2016; 13:2, 112–117. C© 2016 Sigma Theta Tau International
Original Article Four medical-surgical RNs were members of the process for this period of time. Other “skin champions,” Wound Treatment Associates (WTAs), and wound committee members changed as staff terminated their employment, or transferred to other departments. Records were kept from 2005 on plans of action, data collected from chart reviews and studies, and the educa- tional plans, as well as copies of trainings. The prevalence rate is determined through the NDNQI prevalence study, conducted quarterly, by determining the number of HAPUs documented in the hospital on the day of the study. The number of HA- PUs is then divided by the number of patients assessed in the hospital that day. The mean prevalence rate of the combined quarterly studies is the annual mean prevalence rate.
DISCUSSION In order for CMS to make progress toward a decrease in HAPUs, regional and state multidisciplinary health task forces were initiated. The Maine Department of Health and Human Services established a pressure ulcer task force in 2005 (Maine Healthcare Association, n.d.), that included MGMC and CWONs. A literature review from this task force cited two national studies emphasizing the need for action. One was published in the Journal of Wound, Ostomy & Continence Nursing (Whittington, Patrick, & Roberts, 2000), and the other in Advances in Skin & Wound Care (Whittington & Briones, 2004). This sparked the development of a wound committee at MGMC guided by the CWONs and consisting of nurse representatives from medical surgical units, critical care (CCU), operating room (OR), rehabilitation, and float pool. The NDNQI study of HAPUs was started in November 2005, re- sulting in a prevalence of 7.8%. After learning the national rate was 7% (Cuddigan, Berlowitz, & Ayello, 2001), one of the first actions was to recommend nurse training in pressure ulcer prevention (PUP).
Responding in 2006 the CWONs developed a voluntary self- study program with testing on pressure ulcer staging and pre- vention based on the National Pressure Ulcer Advisory Panel (NPUAP) guidelines (Press Ganey Associates, 2015). Those who completed this program were skin-care champions on their units and conducted the NDNQI survey each quarter. Data was collected on each patient on each unit with a bedside skin assessment completed by the “skin-champions,” followed by a chart review with specific categories such as various pres- sure ulcer risk factors, and whether pressure ulcer plans of care were in place. Inter-rater reliability was increased by the CWON assessing patients who were deemed by the skin-care champion to have a hospital-acquired pressure ulcer.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Services
Ace Writing Center has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.
Essays
At Ace Writing Center, Nowadays, students normally have extremely busy schedules. You will note that some of them have to take on some evening or weekend jobs in order to get some income that can help them to sustain in college or in the university. This can deny them a chance to write all the essays given. Others usually get bombarded with a lot of work by their lecturers. This can still delay such students from working on all their essays. However, some of them usually try to work on all these essays but end up delivering their work late. This can prevent them from graduating since most lecturers are strict on deadlines. If you want to write a business essay, the wise way is to hire an outstanding essay writing service like us, so that you can get the best results. If you are keen, you will note that many companies usually overcharge their customers. Some of them are there only to make money. And in reality, they really don’t care to build a long term commitment with students. You should not choose such companies. You should take your time and choose a reliable company to work with. Ace Writing Center is the ultimate solution for you. We have been offering our writing service for more than 7 years. This is a clear indication that you will get quality essay writing service. We have a wide range of writers who can work on any business essay that you might have. We believe in doing extensive research so that we can provide quality work to all our clients. .
Admissions
Admission and Business Papers
Have you ever had to write an admission essay for college? The majority of students face the same issues when applying to a university or college and many in such situations decide they need professional help to cope with this matter. They get in a situation when the deadline keeps coming closer but lack motivation to start because they are just not sure if their writing skills are strong enough. We have a solution for you! Ace Writing Center is the best admission essay writing service with a large professional team and years of experience in providing high-quality papers to students of all levels and faculties. The mission of our team is to help students make their dreams of entering a good college come true and that’s what we offer!.
Editing
Editing and Proofreading
Sometimes all the words for your paper just flow out of your mind and into your fingers. You type quickly at your keyboard and there they are, your beautiful words right there on the screen. But you have no idea how to polish it up. You may be wishing there was a paper writing service that offered this type of writing service. Look no more! Here at Ace Writing Center, we offer you an editing and proofreading option that you can't find anywhere else..
Coursework
College Essay Writing
In case you are familiar Ace Writing Center, you know the way to distinguish a better company from a cheap one exactly. First of all, poor service website does not have a sufficient support. We think support team is an essential part of success; it has to answer all clients’ questions and be a connecting link between clients and their writers. On our web-service you will get answers about anything you need and your writer will receive all your instructions, assignments and requirements exactly and swiftly. A writing service that we run has got a flexible pricing system that will save you from senseless wastes and many bonus systems that let you sparing money for something important for you.
