title: How to reduce hospital-acquired pressure ulcers on a neuroscience unit with a skin and wound assessment team.
abstract: BACKGROUND
  In 2008, the incidence of hospital acquired pressure ulcers (HAPUs) continued to increase on a neuroscience unit that included both neurosurgical and neurological patients in a 14-bed intensive care unit, and in a 18-bed floor unit.
  
  
  METHODS
  To reduce HAPUs, several changes were instituted in 2008; (1) turning patients every 1-2 h/repositioning, (2) specialty beds, and (3) a "skin and wound assessment team (SWAT)" that included one (or two) "expert" nurses/nursing assistants who made rounds on all the patients in the unit at least once a week. They would examine patients from "head to toe", document/measure all pressure ulcers, and educate primary nurses/nurse assistants on the plan/products needed for the patients wound care based on their assessments. In 2010, further measures included: (1) adding eight Stryker beds, (2) adding pressure relieving heel protector boots, and (3) requiring that all new hospital orientees work one shift (7.5 h) shadowing the SWAT team.
  
  
  RESULTS
  The SWAT team initially decreased HAPUs by 48% in 2009; this reduction was further increased in 2010 (57%), and 2011 (61%). Additionally, in 2010, the SWAT team was required to educate nurses in all other units. By 2011, all nurses had to complete the hospital acquired pressure ulcer prevention tutorial.
  
  
  CONCLUSIONS
  Since instituting a specialized SWAT team for our neuroscience unit, the incidence of HAPUs (cost estimated for grade IV, US $129,248) was decreased by 48% in 2009, by 57% in 2010, and by 61% in 2011. The SWAT program is now hospital-wide.
authors.affiliation: Neuroscience Unit, Winthrop University Hospital, Mineola, NY, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: McGuinness
authors.forename: Sherry
authors.initials: S
authors.lastname: Persaud-Roberts
authors.forename: Susan
authors.initials: S
authors.lastname: Marra
authors.forename: Jeannine
authors.initials: J
authors.lastname: Ramos
authors.forename: Diane
authors.initials: D
authors.lastname: Toscano
authors.forename: Linda
authors.initials: L
authors.lastname: Policastro
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein