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Evidence-based nursing: Zero HAPUs: Reaching for the moon
Toni C. Clark MHA, RN, CMSRN

Nursing Management
March 2012 
Volume 43  Number 3
Pages 11 - 12
  PDF Version Available!

When the goal of zero hospital-acquired pressure ulcers (HAPUs) was introduced a few years ago, the common response was that such a goal was like reaching for the moon. Preventing HAPUs isn't an easy task because so many factors can contribute to skin and tissue breakdown during a patient's hospital stay, and it takes multidisciplinary effort to eliminate those factors. Our unit is a 23-bed medical unit focusing on pulmonary and gastrointestinal care. Like most medical-surgical units, we continue to see higher acuity and provide increasingly complex care. Some of our patients are ventilator dependent, and many of our patients have tracheostomies, colostomies, feeding tubes, and limited mobility.In January 2008, we took a long look at our previous year's HAPU rates and reviewed the interventions being used to reduce the rates. Although none of the HAPUs on our unit were stage 3 or 4, and we had made good progress from May through December, the 2007 annual rate of 13 incidents wasn't acceptable, and very far away from a zero goal.Our goal to get to zero HAPUs was realized a few times (in the fourth quarter of 2008 and the second quarter of 2009), but maintaining success was tough. We continued to adjust our plan and monitor our progress, and in 2010, we maintained zero HAPUs throughout the year. We've reached the moon, and we're maintaining our orbit!Just as several factors cause HAPUs, it took several initiatives to prevent them. The first step was the creation of a unit-level skin care team, led by a skin care champion (an RN from the unit) and attended by RNs, patient care technicians (PCTs), a wound-ostomy nurse, and ad hoc physician members. The team conducted a root cause analysis to define strategies, which included: * strengthen the commitment to hourly rounding * adopt a "no diaper" policy * put skin care products under RN control * dual assessment on admittance * use of a bed decision flow chart for mattress selection * creation of a turn team * safety huddles

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