1. M Purpose Improvement Tools/Methods Limitations / Lessons Learned Results Process Improvement Improving Hospital-Acquired Pressure Ulcers at Discharge Ashley Givens, SRN and Santhia Mirtyl, SRN  Hospital-acquired pressure ulcers (HAPUs) have become a growing concern across the world due to patient morbidity, treatment cost, and reimbursement issues; therefore, the management and prevention of HAPUs in high risk patients calls for a need for clinical improvement.  The primary goal is to decrease the occurrence of HAPUs.  The secondary goal is to provide and in-service plan for effective skin assessment.  Despite recent health improvements in healthcare, pressure ulcers continue to be one of the five most common complications experienced by patients and are considered key clinical indicators of the standard and effectiveness of care.  Pressure ulcers are both high cost and high volume adverse events:  In 2007, 257,412 reported cases of Medicare patients obtained a pressure ulcer as a secondary diagnosis during hospitalization; this incurred an average charge of $43,180.  Beginning October 1, 2008, Medicare no longer reimbursed for the extra cost of treating Category/Stage III and IV pressure ulcers that occur while the patient is in the hospital.  In 2013, The Joint Commission included pressure ulcers as one of its’ National Patient Safety Goals. In addition, The Institute for Health Improvement (2011) included pressure ulcer prevention in their 5 Million Lives Campaign initiative.  Educating health care providers on the importance of effective communication, thorough skin assessments, and the implementation of early interventions is key to preventing further skin breakdown.  Assessment  Early screening of all patients with a head-to-toe skin assessment no longer than 6 to 8 hours upon arrival to a facility, including the emergency room.  In addition, use a pressure ulcer risk assessment tool at the time of admission such as the Braden scale.  Training and Education  Provide professional training to educate staff on proper assessment, staging, and interventions.  Educate patients and caregivers on how to prevent and treat pressure ulcers.  Educate students as a part of a core curriculum in primary professional training.  Guidelines/Prevention Strategies:  Turn patient every two hours  Provide pressure redistribution surfaces for bed and chair  Assess nutrition and hydration  Ensure daily or repetitive skin inspection for at risk patients  There were varying levels of health literacy among patients.  Additional research is needed to gain a comprehensive understanding and fill in the gaps for preventing and healing pressure ulcers as it continue to be a major health problem across all healthcare settings  Physicians, nurses, and other healthcare professionals play a vital role in the prevention and management of this common health care issue. Inpatient Unit  Brainstorming  Process flow charting  Chi square comparison of admission assessment and discharge assessment results References  Armstrong, D., Ayello,E., Capitulo, K., Fowler, E., …& Smith, A. (2010). Opportunities to Improve Pressure Ulcer Prevention and Treatment: Implications of the CMS Inpatient Hospital Care Present on Admission (POA) Indicators/Hospital-Acquired Conditions (HAC) Policy.  Australian Wound Management Association. (2012). Pan Pacific Guideline for the Prevention and Management of Pressure Injury. Retrieved from http://www.awma.com.au/publications/2012_AWMA_Pan_Pacific_Gui delines.pdf  Institute for Health Improvement. (2012). Protecting 5 million lives from harm. Retrieved from http://www.ihi.org/offerings/Initiatives/PastStrategicInitiatives/5MillionLi vesCampaign/Pages/default.aspx  Lyder, C. (2003), Pressure Ulcer Prevention and Management. The Journal of the American Medical Association. 289 (2): 223-226.  Lynch, S. & Vickery, P. (2010). Steps to reducing hospital-acquired pressure ulcers. Journal of Nursing. 61 (1). Background Placeholder ( for results of chi square analysis once project completed) Team Members  Quality Improvement Director  Physician who frequently admits patients to the unit.  Registered Nurses on the unit  Nurse Manager Measures  Perform chart reviews to track HAPUs from the time of admission to discharge.  Evaluate compliance at the bedside by performing floor audits to spot-check interventions being performed during each shift.  Conduct a patient survey of current skin integrity 1 hour post admission and 1 hours prior to discharge Flow Chart for HAPU Management and Prevention