Pressure Ulcer Prevention: Innovation and Research Produce Positive Outcomes
MetadataShow full item record
Acquiring a pressure ulcer while in the hospital is a devastating outcome for the patient and their family. Pressure ulcer formation in the medical surgical patient population reflects a gap in practice because it is the nursing staff’s responsibility to reposition and protect the patient from developing pressure ulcers. The purpose of this project was to answer the following question. For patients on a medical surgical unit, how does the implementation of a pressure ulcer toolkit, along with the use of an automated patient repositioner (APR), affect the rate of the hospital acquired ulcers over a ten week period? A medical surgical unit of approximately 20 inpatient beds in a southern hospital experienced an increase in pressure ulcers over that last two years. The plan, do, study, act was the change methodology used to frame the quality improvement project. In addition, Lewin’s theory of change was used to infuse a change in practice for the nursing staff to reposition high risk patients with every patient interaction. After utilizing the Agency for Healthcare Research and Quality (AHRQ) toolkit for pressure ulcer prevention and the use of the APR with every patient interaction, the medical surgical unit went from experiencing three to four pressure ulcers forming on patients each month, to zero for a consecutive three months. The AHRQ toolkit for pressure ulcer prevention supports the use of innovative tools, like the APR, which was successful at preventing pressure ulcer formation for patients highly susceptible for skin breakdown and could be systematically adopted in multiple units in the organization.