1. Hospital Acquired Pressure Ulcers Driver Diagram
OHA HEN 2.0

2. Hospital Acquired Pressure UlcersAI
Primary Drivers
Secondary Drivers
Change Ideas
40% Reduction in HAPU
Conduct skin/risk assessment and reassessment
Implement a head-to-toe skin evaluation and risk assessment.
Utilize a standard tool for the skin evaluation and risk assessment.
Assess skin and risks within 4 hours of admission.
Assess skin at least daily and with other routine assessments.
Risks and assessments to be age appropriate [Pediatric vs. adult]
Visual cues used to promote completion of assessment on the door, in the room or on medical record.
Reassess risk for HAPU at least daily. Develop documentation tools that prompt daily inspections. Use subscales to assess individual risk and drive interventions.
Develop individual plan of care to reduce risk of pressure ulcers.
With patient consent, photograph and document skin issues present on admission.
Include skin assessment during nurse-nurse shift reports to allow for "two sets of eyes". Document and address findings.
Manage Moisture
Avoid skin wetness; protect and moisturize as needed.
Use topical agents that hydrate the skin and form a moisture barrier. Consider using all-in-one cleaning/moisture barrier clothes.
Avoid using a thick paste as a cleansing/moisture barrier as it is difficult to clean when sool is present and may injure skin.
Set specific timeframes or create reminder systems to reposition; frequent toileting, PO fluids, reassess for wet skin. Remember 3 P's - pain/potty/position-pressure

3. Hospital Acquired Pressure Ulcers
AIMN=
Primary Drivers
Secondary Drivers
Change Ideas
40% Reduction in HAPU
Manage Moisture
Avoid skin wetness; protect and moisturize as needed.
Involve licensed and unlicensed (ie: nurse's aides) in hourly rounding and checking the 3 P's.
Consider Stage I pressure ulcer as a "warning" sign.
Use under-pads that dry quickly and wick moisture away from skin. Keep supplies readily available at bedside.
Develop a skin care cart with supplies and guidelines for care based upon severity.
Combine interventions with other routines
Identify a staff nurse in each unit as a skin care resource.
Optimize Hydration and Nutrition
Monitor weight, nutrition and hydration status
Give patients food/liquid preferences to enhance hydration and nutrition.
Assist with meals, encourage snacks
Offer water during hourly 3 P's rounds.
Supply supplements as needed if not contraindicated.
Generate automatic Dietician consult for high risk patient
Monitor weight, intake and lab results
Provide at risk patients with water container with a unique color so staff and family encourage hydration

4. Hospital Acquired Pressure Ulcers
AIM
Primary Drivers
Secondary Drivers
Change Ideas
40% Reduction in HAPU
Minimize pressure, shear and friction
Develop and institute early mobility/ ambulation protocols
Turn and reposition at least every 2 hours
Use visual or musical cues, e.g. a turning clock, bells, alarms at the nurse's station as a reminder to turn and reposition.
Use visual cues at the bedside e.g. a turning clock or whiteboard that displays the time for the next turn.
Establish rules for the side of position such as even hours- right side, odd hours-left side.
Ensure that pressure-reducing equipment is present at all times. (e.g. beds, mattresses, foam wedges) Use a device that elevates heels and prevents external rotation of the foot and ankle.
Operating room tables covered by overlay mattresses
Use breathable glide sheets or lift devices to prevent shear
Use ceiling lifts to encourage mobility and prevent staff injury.
Limit layers of linen to 3. A glide sheet that helps for in-bed mobility and lifts is best for out-of-bed mobility.
Patient/Family Engagement
Family Involvement
Create a culture that supports family/caregiver in the prevention of pressure ulcer.
Allow family, unless contraindicated, to bring in patients preferred food and drink.
Educate family/caregiver on the need for nutrition/hydration.
Educate family/caregiver on 3 P's and allow them t assist where appropriate.
Educate family/caregiver on the prevention and treatment of pressure ulcers at home..