Hospitals can effectively reduce the occurrence of pressure ulcers and lessen patient harm by having a focused approach and engagement from staff. We’re proud to share this patient safety success story from Burnaby Hospital where the incidence of pressure ulcers has dropped significantly. We hope their achievements will inspire others to implement strategies of their own so we can reduce pressure ulcer incidence throughout our healthcare system and improve patient safety across the continuum of care.
Burnaby Hospital is an acute care facility that provides a full range of healthcare services to a diverse population. Approximately 75,000 people visit the Emergency Department each year, and many of the hospital’s inpatients are considered high-risk for developing pressure ulcers due to the nature of their illness or their age.
Pressure ulcer incidence is a useful quality measure to determine the effectiveness of prevention programs. In 2009, the incidence of pressure ulcers at Burnaby Hospital was 62%. The organization made a conscious effort to address the problem and by 2011 incidence dropped to 12%. Today it’s down to 4%.
“We’ve taken a systems approach to this problem at Burnaby Hospital and implemented a combination of strategies because we needed everyone to have a vested interest in this.”
Lisa and her colleague, Misty Stephens, also an Enterostomal Therapy Nurse, are leading the PU prevention campaign at Burnaby Hospital and making it their mission to promote prevention, early detection and early intervention across all areas of patient care. Their commitment and determined focus have been key to Burnaby Hospital’s success, but both agree it’s been a team effort with engagement from all staff and a willingness to improve patient care.
“We couldn’t have achieved 4% incidence without partnering with staff in other areas of the hospital and teaching them how to identify early signs of skin breakdown and how to protect the skin from further damage,” Lisa says.
“You really need the involvement of everybody if you want to see the kind of positive results we have.”
- Availability of two full-time skin and wound specialists (Lisa and Misty)
- Support from hospital leaders and clinical managers
- Ongoing education for staff, patients and families
- Use of standard equipment and a regular maintenance program
- Continence and nutrition management for patients at risk
Burnaby Hospital conducted its bi-annual Pressure Ulcer Prevalence and Incidence Study (P&I) in 2015. Prior to the study, Lisa and Misty collaborated with clinical leaders to set goals, answer questions and obtain support for frontline staff to participate. A multidisciplinary team was then invited to take part (nurses, physiotherapists, occupational therapists, dieticians, hospitalists and others) along with patients and families who appreciated the opportunity to enhance quality of care at Burnaby Hospital.
“We’re very thankful for the support we received for the P&I study at Burnaby Hospital,” Lisa says.
“A lot of staff put their hand up to participate and I think part of that is because Misty and I are really visible at our hospital. Staff know who we are and they come to us when they see something concerning with their patients.”
Staff who participated in the P&I study have developed their skills in pressure ulcer prevention and learned how to do regular skin assessments. The Emergency Department (ED), for example, is moving patients out of the ED and into the wards quicker – to reduce time spent lying in a stretcher – and referring patients to Lisa and Misty when they see signs of serious skin deterioration.
In addition, Burnaby Hospital has implemented standard equipment – bed mattresses, pillows and seat cushions – and a regular equipment maintenance program to reduce pressure on areas of a patient’s body that are particularly susceptible to pressure ulcers.
And to help clinical staff minimize moisture from incontinence, a new “brief-less” protocol was recently introduced. In the ICU, for example, patients are given breathable mesh underwear instead of diapers. “Moisture and heat from prolonged diaper use breaks down the skin and makes it more susceptible to friction, shearing and pressure ulcers,” says Lisa. “This is really about normalizing the patient’s experience while in hospital.
Lastly, Lisa and Misty regularly review pressure ulcer data in BC PSLS to identify which areas of the hospital may be struggling and need their support.
“We use PSLS to learn how, why and where pressure ulcers are occurring in our hospital. It promotes a more holistic approach to patient care and supports a culture of safety across our organization.”
Thanks to the efforts of Lisa and Misty, Burnaby Hospital staff has advanced their knowledge of pressure ulcers and improved patient safety. Their goal is to achieve 2% or less pressure ulcer incidence by their next P&I study in 2017.
- Preventing pressure ulcers: Keeping the pressure on to take the pressure off!
- Pressure ulcers: Raising awareness and promoting prevention in BC
- Protecting patients from pressure ulcers at Royal Inland Hospital
- Compromised Wounds in Canada – CIHI Report
- Preventing Pressure Ulcers in Hospitals
- Canadian Association of Wound Care
- Journal of Wound, Ostomy and Continence Nursing July/August 2015 – Table of Contents outline
Managers at Burnaby Hospital:
- Michael Caron, Manager, Burnaby Hospital
- Theresa Guscott, Manager, Burnaby Hospital
- Dee Dee Wray, Manager, Burnaby Hospital
- Terri Buckle, Manager, Burnaby Hospital
- Katie Quirk, Manager, Burnaby Hospital
- Pat Smid, Manager, Burnaby Hospital
Participants in the Pressure Ulcer Prevalence and Incidence Study at Burnaby Hospital:
- Carly Andre, RCA, Burnaby Hospital
- Dr. Debra Basco, Hospitalist, Burnaby Hospital
- Marissa Cabigting, RN, Burnaby Hospital
- Dimitrije Dejanov, PT, Burnaby Hospital
- Cherrie Isidro, RN, Burnaby Hospital
- Shawn Langlois, RN, Burnaby Hospital
- Lucia Lee, RCA, Burnaby Hospital
- Ryan MacKay, LPN, Burnaby Hospital
- Joanna Miller, RN, Burnaby Hospital
- Alicia Ortega, RN, Burnaby Hospital
- Erin Palmer, Burnaby Hospital
- Dejan Preradovic, Physiotherapist, Burnaby Hospital
- Jodie Pulsifier, PT, Burnaby Hospital
- Sukhi Purba, RN, Burnaby Hospital
- Nicole Robinson, RN, Burnaby Hospital
- Holly Tang, Occupational Therapist, Burnaby Hospital
- Maria Tumamak, Burnaby Hospital
- Marta Udovicic, LPN, Burnaby Hospital
- Sandra Upper, Burnaby Hospital
- Jo Jo Wang, Dietician, Burnaby Hospital
- Liz Wellwood, OT, Burnaby Hospital
- Lilibeth Wood, LPN, Burnaby Hospital
- Grace Wong, RN, Burnaby Hospital
- Arnold Wu, RN, Burnaby Hospital
- Joe Yngresso, RN, Burnaby Hospital
Surrey Memorial Hospital:
- Tanya French, Enterostomal Therapist, Surrey Memorial Hospital
- Jordan Goertz, Enterostomal Therapist , Surrey Memorial Hospital
- Kathy Neufeld, Enterostomal Therapist, Surrey Memorial Hospital