A decrease in the rate of hospital-acquired pressure ulcers at UC Davis Medical Center has earned a Performance Excellence Award from the Collaborative Alliance for Nursing Outcomes (CALNOC).
The award is being presented at CALNOC's annual conference today in San Diego.
Hospital-acquired pressure ulcers (HAPUs) are a national concern due to patient morbidity, treatment cost and reimbursement issues. They are considered among the eight preventable conditions identified by the Centers for Medicare and Medicaid Services (CMS). The cost of treating a hospital-acquired pressure ulcer places a significant burden on health-care facilities. Associated expenses potentially include increased supplies, equipment, specialty beds, staffing, nutritional support, laboratory testing, and hospital length of stay.
During the third quarter of 2014, only one patient at UC Davis Medical Center had a hospital-acquired pressure ulcer, a rate that is well below the historical level for UC Davis and for hospitals nationwide.
From July through September, the hospital had only one patient with a hospital-acquired pressure ulcer. This gave UC Davis Medical Center a rate of lower than 0.5 percent for the period. Historically, the rate of pressure ulcers at the medical center has been at about 2 percent or higher since 2011, but has been falling, said Holly Kirkland-Walsh, a wound care nurse practitioner.
“Our low rate of pressure ulcers is an outstanding achievement, and reflects the dedication and hard work of many, especially our Wound Care Team,” said Carol Robinson, Chief Patient Care Services Officer.
The University HealthSystem Consortium has designated a level of lower than 1.1 percent as a rate that’s within the top quartile of all hospitals.
Kirkland-Walsh attributes the improvement of the ulcer rate at UC Davis to the use of a multidisciplinary team to promote prevention, and changes in hospital policy. The team consists of plastic surgeons, nurse practitioners, wound-certified nurses, physical therapists and dietitians.
The hospital policy promotes early intervention and recognition of pressure ulcers by nurses who, together with physicians, stage and document pressure ulcers present at admission. Nurses also intervene early by ordering specialty-bed surfaces and supplies without waiting for a physician order.
The wound team conducts “road shows” that provide instructions on unit-specific prevention of pressure ulcers, featuring photos and just-in-time learning.
Nurses encouraged to take tutorial
Kirkland-Walsh also credits a tutorial from the National Database of Nursing Quality Indicators (NDNQI) for the hospital’s reduction of pressure ulcers. The wound team makes the tutorial available to all nurses through the Center for Professional Practice of Nursing.
The tutorial enables a more consistent and accurate measurement of hospital-acquired ulcers. It allows hospitals to assess the quality of their prevention care, initiate timely, evidence-based treatment, and to benchmark outcomes.
The NDNQI tutorial provides continuing education credits and educates nurses about pressure-ulcer staging. The wound team recruits groups of nurses to complete the tutorial, and to join the wound team in its quarterly surveys of the hospital documenting cases of pressure ulcers. The wound team also asks graduate nurse residents to take the tutorial and participate in the hospital surveys.
Every year, from 150 to 200 UC Davis nurses complete the tutorial. The NDNQI training supplements the competence instilled by the nurses who take part in the quarterly collection of pressure-ulcer data, said Kirkland-Walsh.