A Toolkit for Improving Quality of Care
Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization. The aim of this toolkit is to assist hospital staff in implementing effective pressure ulcer prevention practices through an interdisciplinary approach to care.
Prepared by: Dan Berlowitz, M.D., M.P.H.; Bedford VA Hospital and Boston University School of Public Health; Carol VanDeusen Lukas, Ed.D.; VA Boston Healthcare System and Boston University School of Public Health; Victoria Parker, Ed.M.; D.B.A.; Andrea Niederhauser, M.P.H.; Jason Silver, M.P.H.; and Caroline Logan, M.P.H.; Boston University School of Public Health; Elizabeth Ayello, Ph.D., RN, APRN, BC, CWOCN, FAPWCA, FAAN, Excelsior College School of Nursing, Albany, New York; and Karen Zulkowski, D.N.S., RN, CWS, Montana State University-Bozeman.
1. Are we ready for this change?
1.1 Do organizational members understand why change is needed?
1.2 Is there urgency to change?
1.3 Does senior administrative leadership support this initiative?
1.4 Who will take ownership of this effort?
1.5 What kinds of resources are needed?
1.6 What if we are not ready?
1.7 Checklist for assessing readiness for change
2. How will we manage change?
2.1 How can we set up the Implementation Team for success?
2.2 What needs to change and how do we need to redesign it?
2.3 How should goals and plans for change be developed?
2.4 Checklist for managing change
3. What are the best practices in pressure ulcer prevention that we want to use?
3.1 What bundle of best practices do we use?
3.2 How should a comprehensive skin assessment be conducted?
3.3 How should a standardized pressure ulcer risk assessment be conducted?
3.4 How should pressure ulcer care planning based on identified risk be used?
3.5 What items should be in our bundle?
3.6 What additional resources are available to identify best practices for pressure ulcer prevention?
3.7 Checklist for best practices
4. How do we implement best practices in our organization?
4.1 What roles and responsibilities will staff have in preventing pressure ulcers?
4.2 What pressure ulcer practices go beyond the unit?
4.3 How do we put the new practices into operation?
4.4 Checklist for implementing best practices
5. How do we measure our pressure ulcer rates and practices?
5.1 Measuring pressure ulcer rates
5.2 Measuring key processes of care
5.3 Checklist for measuring progress
6. How do we sustain the redesigned prevention practices?
6.1 Who will be responsible for sustaining active pressure ulcer prevention efforts on an ongoing basis?
6.2 What types of ongoing organizational support do we need to keep the new practices in place?
6.3 How can we reinforce the desired results?
6.4 Summary and plan for moving forward
7. Tools and Resources
Key Subject Area Index
This project was funded under contract number HHSA 290200600012 TO #5 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.
Additional support was provided through the U.S. Department of Veterans Affairs under grant # RRP 09-112.
The development of this toolkit was facilitated by the assistance of quality improvement teams at six medical centers: Billings Clinic, Boston Medical Center, Denver Health Medical Center, Montefiore Medical Center, VA Connecticut Healthcare System (West Haven Campus) and VA North Texas Healthcare System (Dallas Campus). We thank them for their valuable contributions. We also thank Barbara Bates Jensen, Ph.D., RN; Sharon Baranoski, M.S.N., RN, CWCN, APN, FAAN; Joy Edvalson, M.S.N., RN, FNP, CWOCN; Aline Holmes, M.S.N., RN; Diane Langemo, Ph.D., RN, FAAN; Courtney Lyder, Ph.D., RN; and George Taler, M.D., for their advice on this document.