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October 1, 2007 (San Jose, CA) – To improve something, you first need to understand how it works. Clinical nursing staff at the bedside are key to finding solutions to problems that involve clinical care. O’Connor Hospital, in San Jose, California, took on the challenge of improving the way pressure ulcers are treated and prevented.
The hospital successfully reduced the occurrence of Hospital-Acquired Pressure Ulcers (HAPU) in their patient population from 24 percent in September 2006 to 2.7 percent as of September 23, 2007. The national average is seven percent.
Prompted by their core value of Respect, the Daughters of Charity Health System, located in Los Altos Hills, California, began a system-wide skin integrity initiative in March 2005 to lower the number of Hospital-Acquired Pressure Ulcers, also referred to as bed sores. A focused area for respect and clinical 
care was in the area of care for the elderly, a large and high-risk portion of their patient population. One of the most significant risks the elderly face during a hospital stay is skin break-down.
A multi-disciplinary Skin Integrity Task Force made up of nursing directors and managers, nurse educators and staff nurses from the bedside, rehabilitation and quality staff conducted a preliminary HAPU study that revealed many opportunities to reduce a patients’ risk of pressure ulcers. Quarterly rounds in the ICU, PCU, Med/Surg, TCC, NICU, Pediatrics and the Orthopedic unit are continually conducted to evaluate the process outcomes.
Daily assessment, weekly rounding and evaluations of care plans are performed to report the patients’ pressure ulcer skin status. Staff nurse input has been crucial in the success and utilization of this initiative. “For example, staff nurses on the committee solicited input from their nursing peers on what needed to change to bring our pressure ulcer events down, then brought the valuable feedback back to the team, resulting in revamped and user-friendly Pressure Ulcer Packs (PUP), protocols, tools, and resources,” said Deirdre Hegarty, RN, BSN, senior director of Medical-Surgical Services and team chair. “The work is ongoing, and a feeling of teamwork spurred the group members to want to improve upon current processes, sharing their own expertise, experience and real-world dilemmas.”
Hospital-Acquired Pressure Ulcers have now become an initiative for the Institute for Health Improvement’s “Save Five Million Lives” campaign, as well as a well-established quality of care outcome for nursing by California Nursing Outcomes Coalition.