Hospital Reduces Pressure Ulcer Prevalence with “Always Practices”

Northwestern Memorial Hospital in Chicago, IL, introduced a hospital-wide, collaborative quality improvement initiative using process improvement methodology to reduce pressure-ulcer prevalence in the facility. The program, described in the September 2009 issue ofJONA, involved the creation of “always practices” designed to make skin assessment a priority and resulted in a 50% reduction in stage III and IV pressure ulcers. The project was undertaken after the facility determined that incidences of pressure ulcers had increased and exceeded national benchmarks despite 95% staff adherence to the Braden scale for predicting pressure-ulcer risk.

Nursing administrators spearheaded the project while nurse management and quality improvement staff monitored its progress. Key stakeholders included staff from the following departments: claims and litigation, emergency medicine, hospital improvement, information systems, medicine, nutrition, and surgery, as well as all nursing staff. Strategies included frequent cross-departmental communication, formal education for bedside caregivers, and defined responsibilities for attending physicians and resident physicians. Subgroups focused on skin assessment and pressure-ulcer prevention and treatment and determined resources needed to improve skin-care management on a day-to-day basis. “Always practices” were developed to ensure that skin care was made...