But the financial penalties aren't the reason for increased efforts, she says.
Rather, it was "public reporting of these conditions that really got our attention. It's not like we didn't know we had them, but we didn't have rates we could compare with other hospitals. And ours was a pretty high rate."
The hospital already had a wound care nurse who was part time but decided to increase that to full time, and gave the nursing support staff additional education so they have wound care certification. Sonora's expanded efforts include working with Premier healthcare alliance's Hospital Engagement Network and looking at where its patients were getting pressure ulcers, such as around the ear due to oxygen tubing friction.
And it turned out that a lot of the ulcers occurring were associated with nasal cannulas used to deliver oxygen. Leaders realized that they could purchase different products that reduced the risk, such as a cannula that had a padded part that fit over the ear.
Elastic stockings, special cold pads, and skin inspections of patients every 12 hours or at the start of every shift change were also implemented, "so we can catch problems early and implement these tools to keep any redness from developing into a pressure ulcer," Hukari says.
Sonora has also given more attention to patient nutrition, to beef up calories and the amount of protein to speed wound healing.
At 382-bed WellStar Cobb Hospital in Austell, Ga., the two-year preventable pressure ulcer rate for the period that ended June 30, 2011, was 0.239, higher than the national average of 0.136 per 1,000 eligible discharges.
Marcia Delk, MD, WellStar Cobb's senior vice president for safety, quality, and credentialing and chief quality officer, says that failure to document patients who came in with pressure ulcers was one reason the hospital might have looked worse than it was.
"Previously, nurses would recognize a pressure ulcer and start interventions, but they didn't document it. It took a little time for the team to understand what those needs were and make sure they reflected [them] in the record."
Other practices include the use of what Delk calls a "turn and assist" product to protect the sacrum, a common site of pressure ulcers. The product is made from parachute-like material that reduces friction and slipping, absorbs moisture, and helps staff reposition patients.