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Knock Pressure Injury Rates Down to Zero: 5 Ways

Analysis  |  By Jennifer Thew RN  
   October 18, 2019

Temple University Hospital's interdisciplinary Dermal Defense Team stopped Stage 3 and 4 pressure injuries acquired after admission at their organization to improve patient care and outcomes.

This article appears in the November/December 2019 edition of HealthLeaders magazine.

At Temple University Hospital, Stage 3 and Stage 4 pressure injuries acquired after admission have truly become never events, thanks, in part, to the work of the organization's Dermal Defense Team.

In 2018, the team set out to achieve zero Stage 3 and Stage 4 pressure injuries developed by patients after a hospital admission. Through education, risk assessment, and other prevention protocols, the goal was met in quarter three of 2018. In recognition of its work, the team received the 3M Award for Excellence in Skin Safety in June 2019.

Stage 3 and Stage 4 pressure injuries acquired after admission at healthcare facilities are some of the offenders that make up the list of 29 "serious reportable events" in healthcare, and according to the Agency for Healthcare Research and Quality, pressure injuries cost the U.S. healthcare system an estimated $9.1–$11.6 billion annually.

While the high cost of pressure injuries is motivation enough to eliminate their occurrence, finances weren't necessarily the driving force behind the Dermal Defense Team's goal.  

"The community that we serve is, in a lot of ways, impoverished and [community members] lack a lot of standard medical care," says Meghan Dunleavy, BSN, RN, a nurse in the surgical ICU at Temple University Hospital, and a member of the Dermal Defense Team. "It really was that people in this community need just the absolute best-quality nursing care."

Top-quality nursing care is something all nurse leaders are eager to replicate. Here are five ways the Dermal Defense Team has achieved success tackling pressure injuries.

1. Get Support From Administration

Diane Wagner, MSN, BSN, RN, CWOCN, clinical nurse specialist and Dermal Defense Team program chair at Temple University Hospital points out to improve care at the bedside, there must be support from hospital leadership.

"[When the Dermal Defense began in 2014], we had a team from the nursing education department, and then we would ask for volunteers from the nursing floors. It could be really destitute at times, or staff would get called back [to the unit] to work. We just couldn't get any momentum under it," she says.

But much has changed under the current nursing administration. There are now over 50 staff members on the committee, and Wagner says nursing staff are rarely called back to the unit during the meetings.

Dunleavy says discussions with nurses at different organizations made her realize how necessary administration's support is to reach success.

"What I heard from a lot of nurses is that it's very difficult to maintain a group for meetings when nurses are being called out of that meeting or they're not being properly covered on the floor when they're in that meeting.  They tend to worry, [about their patients], and they don't focus on the meeting that they're attending. That's something that I hadn't realized," she says.

At Temple, most of the Dermal Defense Team committee members are not scheduled to work on the unit on days the meetings occur. Instead, they are paid to come in to attend the meeting. This allows managers to ensure units have appropriate staffing that allows committee members to implement changes and participate in meetings.

2. Use Compassion as a Driver of Change

At Temple, says Dunleavy, doing the right thing for patients was the real driver of change to achieve zero cases of Stage 3 and 4 pressure injuries after admission.

"What you find is a lot of our patients come in with comorbidities that are untreated. They don't have home supports, so you have a lot of elderly in the community that aren't receiving good medical care," she says. "We recognized that we wanted to serve [the community] more. It was genuine compassion towards our patients [from which] the whole program was driven. We wanted to improve and to take away that risk [of pressure injuries] because they have so many other risks that they deal with on a daily basis."

3. Make Care a Team Effort

Members on the Dermal Defense Team include representatives from almost all the hospital's nursing units, including the operating room, and some nurses from the evening shift, Wagner says.

"Then, as time went on, the patient care assistants became part of the committee as well. We felt they were just critical to being part of this committee and getting the work done that, and they have been invaluable," she says.  

Wagner says the committee continues to grow across disciplines.

"We added physical therapy. Respiratory care has expressed interest in being part of the committee, and dietary has done different things with us," she says.

4. Educate Staff Members

The beginning of each Dermal Defense Team monthly meeting begins with an educational presentation for committee members who then disseminate that information to staff on the nursing units.

"We've done education with the staff around staging," Wagner says. "The Dermal Defense Team members will huddle with the staff and talk about what we're working on and remind people about the care they need to perform," she says.

One example of this is the team's Back Off program.

"Our premise is that people spend a lot of times on their backs between eating and tests, so now instead of the usual side-back-side-back, we just turned people side to side. That's something we've implemented," she says.

Additionally, team members collect unit-specific data and create posters that are part of a larger Dermal Defense Team display.

"[The posters] will show the results of that day so [the team] can see how many patients were looked at, and whether or not anybody had a pressure injury. We also collect data on how many layers of linen patients are on and that goes on the poster as well. They also take that information and communicate that with their staff as well," she says.

5. Be Highly Visible

In addition to huddles, rounds, and posters, the Dermal Defense team members maintain a public profile by wearing bright yellow team t-shirts that say, “To Prevent, Protect and Save,” during monthly data collection rounds.

"The t-shirts have done a couple of things. They've identified and unified us as a team. They also made the staff and patients aware of what we're doing," Wagner says.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


To improve patient care and outcomes, leadership support is needed.

Dedicating nurses' time to quality improvement is necessary for success.

Interdisciplinary collaboration is key to high-quality patient care.

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