Facility Lowers Rate of Pressure Ulcers

Along with using the initial assessment during a patient's admittance, McInerney and her team determined that all patients with end-stage renal disease who were on hemodialysis and all patients using ventilators would automatically be required to wear the boots.

McInerney says it was important to empower staff members to use their discretion when judging whether the use of a boot is necessary with a particular patient.

"[Even though we were already using the] initial assessment—less than 13 on the Braden scale—and the boot protocol [as indicators], we also wanted to make it clear to staff that if they thought a patient was at risk, and they did not fall into predetermined categories, to give them a boot," says McInerney.

Visible success and results maintained
Since NCH first saw its pressure ulcer prevalence numbers drop between January and July 2002, the facility has continued to see success.

"The fact that the idea of lowering NCH's pressure ulcer prevalence has been drilled into the staff members' heads has really helped our numbers," says McInerney. "It's such a part of our life now, and I have no painful memories of this process."

McInerney created posters and flyers displaying a foot on a mattress with a red slash to illustrate that patients at risk for pressure ulcers should not have their feet on the bed, but rather elevated in a boot. In addition, NCH's CEO discussed the pressure ulcer rate in his weekly newsletter.

Another factor that helped NCH maintain a low pressure ulcer rate was the decision to upgrade the system's hospital beds. In 2004, nurses purchased pressure-relieving, continuous lateral rotation therapy air mattresses for critical care units, and other units in the hospital received pressure-reducing foam mattresses.

NCH continues to have great success keeping pressure ulcer numbers low. In the past two years, NCH's pressure ulcer rate has remained under 2%, reports McInerney.

"I attribute a lot of our success to the product itself," she says. "But you have to remember that it takes persistence. The idea of electronic records which force consults to make sure everyone is covered may cause some overlap. But compared to what you save on preventing pressure ulcers and that it is the right thing to do, one has to focus on the bigger picture."