Implementation of a Pressure Ulcer Prevention Protocol in a Coronary Care Unit

Healthcare clinicians perceive care standardization as a requirement. Hospital Acquired Pressure Ulcers (HAPU) is a leading cause of preventable harm. It is associated with a significant increase in treatment cost, length of stay, and poor patients’ satisfaction. This project applies the principle of care processes standardization via developing and implementing evidence based Pressure Ulcer Prevention Protocol (PUPP). A comprehensive process starts on admission and continues throughout the course of hospitalization in the Coronary Care Unit (CCU). Patients are risk adjusted using the Braden assessment scale to segregate patients who need rigorous Pressure Ulcer (PU) preventive interventions from those who require standard preventive measures. Quality improvement tools and frameworks are integrated into Senior & Swailes organizational development model to implement the project. Measurement and evaluation include patients’ outcomes, performance measurement, and evaluation of barriers to care processes standardization. The PUPP integrates change management and quality improvement tools and frameworks. The results of the first quarter of 2014 revealed one confirmed PU with a significant drop in the reported adverse events relevant to PUs. However, the decline in the number of reported events may be attributed to the introduction of new ‘safety reporting system’ (SRS). The project has several limitations; the evaluation period is too short for the outcomes to materialize. Furthermore, accurate measurement of PUs requires more specific measurement tools such as ‘trigger tool.' Barriers to care standardization include lack of awareness of the care sets, as well as diverse patients’ preferences.