"It was a matter of realizing we did have an opportunity here, and it was an issue across the country—and that we need to have the focus on what we can do here to make a difference," says Whitworth.
When it comes to preventing HAPUs, making sure that patients are turned every two hours is a huge component, says Whitworth. The challenge is determining whether this is actually happening, or what to do for critically ill patients in pediatrics, for example, who can only be turned every 12–24 hours, she explains. Another area that is a huge concern is device related injuries such as oxygen tubing around ears. Lastly, making sure that the staff is onboard with the processes.
Historically, St. Mary's used what it calls a point prevalence and incidence report where, on a yearly basis, it examined everyone's skin across the whole hospital. It then came up with its HAPU rate—meaning these patients came into the hospital without a pressure ulcer and now they have one. It wasn't the best system, Whitworth concedes. "One snapshot, once a year is not the best way to determine what your patient population has." Now these evaluations are done quarterly.
In addition, as soon as a HAPU is identified, the wound care team and nurse manager are also notified. "We immediately start doing a review and make sure the interventions are correct or if we should escalate them," she says. The CNO also wanted to know about these events, Whitworth adds, so if one occurs it is included in the daily 10:30 a.m. huddle with the nurse managers, assistant director of nursing, and department heads. The huddle discusses what is going on throughout the facility, for example what is the ED looking like today.