In 2008, The Centers for Medicare & Medicaid Services stopped paying hospitals for the increased cost of care for stage three and four HAPUs, which it classifies as never events.
The statistics are staggering, says Whitworth. "These are patients that came to us without this issue, and this is what we have added on to their list of morbidities—if not mortality."
St. Mary's Hospital in Richmond, VA, part of the Bon Secours Health System, always looked at its HAPU statistics on a yearly basis, says Whitworth, who is the manager of the wound care team at St. Mary's. "But it wasn't a concentrated focus," she says. Then in 2006, some areas of the hospital were showing HAPU rates at 20%. The national average at the time was roughly 5%–6%, says Whitworth. "We said 'This is totally unacceptable.' We set up a goal and started our 'journey to zero.' It was a pretty lofty standard, but that was the vision."
Everyone in the hospital from board room and chief nurse executive-level to the bedside nurse is now focused on preventing HAPUs. Whitworth says there needs to be a commitment that the resources will be there for prevention. "For us, it is that we can have skin champions who can meet monthly for an hour and have skin care meetings," she says, adding that if a patient needs a different bed surface, the staff nurses are empowered to get it for them. They do not need to wait for approval from the wound care nurse, she says.
To ensure St. Mary's was doing everything it could to prevent HAPUs, it created an interdisciplinary team, including nurses, physicians, dietary, physical and occupational therapy, and quality staff, to review processes and guidelines. St. Mary's also brought in subject matter experts and conducted research reviews.