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Pressure Injury Prevention in an Acute Care Hospital

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Monday, October 1, 2018

Pressure injuries can occur at any point during a patient’s stay in an acute care hospital. Due to the pervasive risk of hospital-acquired pressure injuries (HAPI), Arrowhead Regional Medical Center (ARMC) has focused extensive resources to preventing these adverse events from occurring while our patients are hospitalized.

At the start of their program in 2012, ARMC had a higher than expected point prevalence rate of 7% and knew they had to do better. A dedicated interdisciplinary team was assembled and the work began. In August of 2018, ARMC's year to date rate was 0.42%. In July, on survey day, ARMC had no patients in the hospital with a HAPI!

Several key elements have proven essential to ARMC's success. Armed with the knowledge that change happens at the unit level, a team of dedicated “Master Stager” nurses was organized—who perform head to toe skin checks every Wednesday. These nurses ensured a nurse-driven prevention program called the Pressure Ulcer Pressure Injury (PUPI) was implemented. The policies include acuity-adjusted bundles of care which is the core of the PUPI prevention program. PUPI includes these intervention bundles—education on these bundles and to the importance of pressure injury prevention is embedded in every level of staff member education. 

ARMC merged their Safe Patient Handling Program with a Mobility Program called MOVE ME to ensure bedside care providers can mobilize vulnerable patients without personal injury. This involved a huge investment in state-of-the-art mobility equipment. 

ARMC has a top down and bottom up safety culture which supports transparency and improvement. There is still work to be done. With every intensive analysis of a new HAPI, gaps are revealed, and addressed. The key to success is Sustaining the Gains on our journey to zero HAPIs!

For more information contact Fran Dyckman, MSN, BSN, RN, CNS, CWOCN, Certified Nurse Specialist Department of Education, Arrowhead Regional Memorial Center, at: dyckmanfr@armc.sbcounty.gov