Parkwest Responds to Pressure Ulcer Challenge

Posted on October 12, 2012

Quality improvement often begins with a challenge.

When Parkwest Medical Center noticed an increase in hospital-acquired pressure ulcers, staff saw this as an opportunity to change the culture and improve processes while making hospital stays safer for patients. Pressure ulcers are painful sores that are caused by pressure on the skin, mostly from staying in the same place too long or from friction from an inserted tube or device. There are four stages of pressure ulcers based on level of severity, and most are preventable with nursing intervention.

In 2008, Parkwest formed the pressure ulcer prevention (PUP) team. The multi-disciplinary group included educators, wound care nurses, managers and dietary specialists who began gathering data and brainstorming possible solutions to decreasing their rates. The team tried numerous approaches in searching for the right solution. They studied individual cases of any stage 2 or above pressure ulcer in-depth, reviewed products and evaluated situations from a clinical and financial perspective. The team also gauged the Parkwest staff’s current knowledge about pressure ulcer prevention. With a rate of 2.5-2.7 instances per 1,000 patient days at the beginning of trials, they knew their numbers had to improve.

“We had a culture of providing the best possible care for the patient, and this was something we had to invest in,” said Sharon Monday, manager, clinical improvement and compliance.

The team implemented multiple strategies staggered over time in order to determine which ones were effective and which ones were not. They began with pilot programs on 1-2 units, and then went hospital wide at once. Developing standards and training staff occurred quickly, often within two to three months.

The steps included shifting a patient’s position every two hours, refraining from applying any extra pressure on boney points, paying special attention to a patient’s heel, nose and ears, ensuring their nutrition and looking at different securing devices to hold tubes. Nurses initially screened patients to determine their risk factors and conducted an assessment every shift of their skin to determine an appropriate intervention.

The process was not without roadblocks, however. One initial trial in an orthopedic nursing unit had staff being paged every two hours to remind them to turn or reposition their patients. The result was that staff become overstimulated and stopped paying attention to the notifications. Another attempt at education involved posters depicting the Braden Scale being placed in the cafeteria and other public spaces. The PUP team soon found those they were targeting often were in such a hurry that they did not even see the posters, much less spend time reading them.

However, the PUP team soon found several solutions to engaging and energizing their busy staff. A pink paw print logo was developed to represent the initiative, and soon it became a magnet that was placed on the doorframe of high-risk patients. The bright color stood out, prompting anything associated with pressure ulcers to be colored pink, including tracking forms and initial assessments.

A pamphlet was developed for patients and families, who often are unaware of the risks pressure ulcers pose. The PUP team also began sending out personal thank you cards to nurses or staff who did something to prevent pressure ulcers. In addition, the team found that screensavers on hospital computers provided a great way to share information about declining rates or additional prevention techniques.

Today, the PUP team is one of the longest running teams at Parkwest. Rates for pressure ulcers have been improving for the last three years and currently sit at .8 per 1,000 patient days. While they are pleased with their progress, they know there is always more work to be done.

“We are constantly asking ourselves, what else can we do to provide better care?” Monday said.


  • Have resource staff available that has been trained, as well as resident experts, on hand to educate staff and patients.
  • Make sure your team is committed to the goal. Meet monthly; stress the importance of sustainability.
  • Foster the mentality that there is always room for improvement.
  • Don’t forget to consider how one team in the hospital can affect another.
  • Multidisciplinary focus groups are key. Each works interdependently.
  • Utilize PDSA: Plan, Do, Study, Act
  • Remember that what is best for the patient comes first.
  • Demonstrating best practices for others is very motivating.
  • Enjoy the recognition that comes with success.