If there is a HAPU, the staff nurse, nurse manager, and one of the wound care team show up and explain what is happening. "Within 24 hours, we already have a handle what we can do to prevent it—what process or education do we need," says Whitworth.
The hospital always had a skin and wound care committee that met monthly and focused on education and what the current HAPU issues were on the floor. But it wasn't focused on prevention, which is now its main focus, says Whitworth. It also expanded the committee to represent all units. It didn't have pediatrics, surgical services, or the emergency department represented, for example.
It is imperative for hospitals to identify HAPUs that are present on admission, she explains. If a patient comes into the ED with a heart attack, the focus is on the heart attack. But as soon as that patient is stable, St. Mary's set the standard that staff need to do a skin and risk assessment.
The hospital restructured its staff education process as well. St. Mary's wanted to know whether its staff could assess patients, do a grading scale, and score them appropriately. "If patients weren't scored correctly, we weren't putting in the interventions," says Whitworth. St. Mary's now has mandatory competencies and annual skills reviews solely on skin and pressure ulcer prevention.
Each unit also has a skin champion who performs process data collection on a weekly basis, she says. They look at the care of five patients on their unit and evaluate the processes the team excels in or needs to work on. Some units maybe good at turning but struggle with handoffs, Whitworth explains, so this brings it to the unit-level rather than setting a hospital-wide initiative to focus on turning.
Hospitals should ensure that HAPU processes are not duplicate work and that they are as user-friendly as possible, says Whitworth. For example, St. Mary's developed a list of interventions that staff should do based on the HAPU's level. The system is now automated in its electronic medical record, but they had a paper version prior to launching the EMR.