1. Hospital Acquired Pressure Ulcers

2. Background – Harm Incidence of Stage II or greater > Hospital- Acquired Pressure Ulcers ranges from 5% - 9% 60, 000 die from pressure ulcer complications each year

3. Background – Harm Decrease quality of life and functionality Increase risk of other complications Increase hospital mortality Increase need for skilled care and rehab after discharge

4. Who get’s pressure ulcers? Spinal cord injuries & elderly Higher incidence in hospitals (38%) not nursing homes (23.9%) Pressure ulcers do not always signify poor care Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296:974-984.

5. Co-Morbidities

6. Pathogenesis for HAPU

7. Friction

8. AIM Reduce the prevalence of hospital acquired Stage II or greater pressure ulcers from 2010 baseline rate by 50% by December 31, 2013

9. Suggested Measures Outcome Patients with at least one Stage III or greater hospital acquired pressure ulcer Process Skin assessment documented within 24 hours of admission HAPU risk assessment completed within 24 hours of admission

10. AIMPrimary DriverSecondary Driver

11. Primary Driver: Conduct Skin & Risk Assessment

12. Head to Toe Risk Assessment Within 4 hours of admission At least every day Check skin during routine care, i.e. turning, bathing

13. Take Action! Plan of care & interventions based on skin & risk assessment

14. Include Skin Risk in Handoffs

15. Primary Driver: Manage Moisture

16. Balance Need for Dry but Moisturized Skin

17. Use Under Pads to Keep Skin Dry Will hold up to 1 liter & Keep skin dry!

18. Use ‘Reminders” P = Pain P = Potty P = Position or Pressure 3 P’s

19. Primary Driver: Optimize Hydration & Nutrition

20. Monitor… Weight Hydration status

21. Offer Appetizing Food & Drink Choices Tempt patient with food & drink they like Consider cultural food preferences

22. Additional Interventions: Consult a registered dietician Consider nutritional supplements

23. Primary Driver: Minimize Pressure, Shear, & Friction

24. Turn! Turn! Turn! Turn & reposition at least every 2 hours

25. Pressure Relieving Special Surfaces & Tools Foam wedges to position patients Special pressure redistributing/relieving mattresses Use pillows only for limbs Heel boots

26. Early Mobility & Ambulation Staff driven protocolGet patients moving! Includes assessment of patient strength & weaknesses Includes ‘opt out’ for contraindications Triggers referral to physical therapy based on criteria

27. Minimizing Shear & Force Use lifts to reposition Breathable glide sheets Limit linen layers to no more than 3 Foam sacral dressing

28. Key Resources AHRQ Toolkit: Preventing Pressure Ulcers in Hospitals AHRQ Guideline Synthesis on Preventing Pressure Ulcers National Pressure Ulcer Advisory Panel IHI: How to Guide on Reducing Pressure Ulcers Hughes RG (ed). Patient Safety and quality: An evidence- based handbook for nurses. AHRQ Publication No. 08-0043, Rockville, MC: Agency for Healthcare Research and Quality; April 2008 Gibbons W, Shanks HT, Kleinhelter P, Jones P. Eliminating facility-acquired pressure ulcers at ascension health. JC J Qual Pt Safety. 2006;32(9).488-496.