title: Sustaining pressure ulcer best practices in a high-volume cardiac care environment.
abstract: \Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India (now known as the Narayana Institute of Cardiac Sciences), is one of the world's largest and busiest cardiac hospitals. In early 2009, NHCH experienced a sharp increase in the number of surgical procedures performed and a corresponding rise in hospital-acquired pressure ulcers. The hospital sought to reduce pressure ulcer prevalence by implementing a portfolio of quality improvement strategies. Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers. By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program's success and sustainability include strong leadership, nurse and physician involvement, an emphasis on personal responsibility, improved documentation and communication, ongoing training and support, and a portfolio of low-tech changes to core workflows and behaviors. Many of these elements are applicable to U.S. acute care environments.
authors.affiliation: Rohini Paul is nursing superintendent in the Department of Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, Karnataka, India. Stacey Paris McCutcheon is an independent medical writer based in Menlo Park, CA. Stefanos A. Zenios is a professor of health care management in the Graduate School of Business, Stanford University, Stanford, CA, where at the time of writing Jenna Penelope Tregarthen was an innovation instructor and Lyn Thayer Denend was director of the Program in Healthcare Innovation. Currently Tregarthen is chief executive officer at Recovery Record, a digital health care company, and Denend is associate director of curriculum for Stanford Biodesign, a Stanford University initiative. The research for and development of this article was supported by a grant from Fogarty International Center and the National Institutes of Health (RC4 TW008781). Contact author: Jenna Penelope Tregarthen, jenna.treg@gmail.com. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.
authors.forename: Rohini
authors.initials: R
authors.lastname: Paul
authors.forename: Stacey Paris
authors.initials: SP
authors.lastname: McCutcheon
authors.forename: Jenna Penelope
authors.initials: JP
authors.lastname: Tregarthen
authors.forename: Lyn Thayer
authors.initials: LT
authors.lastname: Denend
authors.forename: Stefanos A
authors.initials: SA
authors.lastname: Zenios
mesh_terms: D002318:Cardiovascular Diseases / Q000601:surgery / Q000628:therapy; D004509:Education, Nursing, Continuing; D055317:Evidence-Based Practice; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D007194:India; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000517:prevention & control* / Q000628:therapy