Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics
2.1. The UMH PUPP Experience
2.2. Pressure Ulcer Prevalence
2.3. UMH Demographics
- Replacement of all inpatient support surfaces with Hill-Rom Advanced Microclimate ® (Hill-Rom, Chicago, IL, USA) Technology mattresses, considered the next generation of low air loss which is thought to remove excess heat and moisture helping patients skin remain dryer.
- Implementation of a new comprehensive plan for assessment and monitoring of patients with HAPUs, which included the photographing of all wounds on Wednesdays for ongoing evaluation and management.
- Support surfaces replacement in the operating room for prevention of deep tissue injury and skin breakdown.
- One protocol triggered nurses to implement preventive measures on patients who scored 18 or below on the Braden Scale, and to initiate treatment of either stage one or two pressure ulcers. The protocol defined the specific plan of care for those patients. The nursing staff was empowered to initiate wound care treatment without waiting on consultation from the wound care nurses.
- A second protocol established a hospital-wide monthly and quarterly pressure ulcer surveillance process. The surveillance included specific unit rounding logs. The logs specifically identified patients who were admitted with either a “present on admission” (POA) or who developed a “hospital acquired pressure ulcer” (HAPU). The wound care committee reviewed these data and each inpatient nursing unit was informed of their hospital acquired wound rate. This information is then placed on the unit specific hospital pillar boards quarterly for all staff to review. The committee encouraged the managers and directors to perform weekly morning huddles addressing their wound care issues. To broadly engage the staff with participation, those inpatient units who had achieved zero HAPU rates were rewarded with monthly lunches.
- The committee reinforced “repositioning” as a basic tenet of nursing care to prevent pressure ulcers. Most repositioning policies are based on historic recommendations and supported by current best practice guidelines .
- Mallah et al. also recommends repositioning the bed-ridden patient every two hours to help eliminate interface pressure ulcer development .
- In order to enable our staff to reposition the bed-ridden patient every two hours, the committee sought the support of executive directors and nurse managers to increase the number of nurse assistants on each unit to three or four and to enforce hourly rounding to bedridden patients. The newly hired staff was utilized to aid the non-bedridden patients get out of bed to chair—critical to the success of meeting the intent of a repositioning protocol.
- Skin care policies were implemented to standardize the prevention and care of all HAPU.
- Re-education on Braden Scale was mandated in order to identify patients at higher risk of HAPU and to initiate early intervention.
- A wound, ostomy, and continence (WOC) nurse was added to staff to lead and coordinate the skin maintenance and management programs and to provide continuous education and training for the patient care staff. The WOC nurse holds monthly product evaluations, education, and review with wound care champions representing the various hospital units.
|Program Participants||Average Pre-test %||Average Post-test %|
|Certified Nursing Assistants||75%||98%|
Challenges and Successes
Conflicts of Interest
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© 2015 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).
Cano, A.; Anglade, D.; Stamp, H.; Joaquin, F.; Lopez, J.A.; Lupe, L.; Schmidt, S.P.; Young, D.L. Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics. Healthcare 2015, 3, 574-585. https://doi.org/10.3390/healthcare3030574
Cano A, Anglade D, Stamp H, Joaquin F, Lopez JA, Lupe L, Schmidt SP, Young DL. Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics. Healthcare. 2015; 3(3):574-585. https://doi.org/10.3390/healthcare3030574Chicago/Turabian Style
Cano, Amparo, Debbie Anglade, Hope Stamp, Fortunata Joaquin, Jennifer A. Lopez, Lori Lupe, Steven P. Schmidt, and Daniel L. Young. 2015. "Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics" Healthcare 3, no. 3: 574-585. https://doi.org/10.3390/healthcare3030574