Preventing pressure ulcers: the goal is zero

BACKGROUND: One of the 12 interventions that the Institute for Healthcare Improvement (IHI) recommends for its 5 Million Lives Campaign is "Prevent Pressure Ulcers ... by reliably using science-based guidelines for their prevention." Pressure ulcers cause considerable harm to patients, hindering functional recovery, frequently causing pain, and often serving as vehicles for the development of serious infections. Although the goal for health care facilities to reduce pressure ulcers is admirable, the goal for pressure ulcer incidence should be zero. THE CASE FOR PREVENTION: Pressure ulcer prevention entails two major steps: identifying patients at risk and reliably implementing prevention strategies for all patients identified as at risk. Prevention strategies include six key elements (elements 3-6 address patients at risk): (1) conduct a pressure ulcer admission assessment for all patients, (2) reassess risk for all patients daily, (3) inspect skin daily, (4) manage moisture, (5) optimize nutrition and hydration, and (6) minimize pressure. Facilities may wish to form a multidisciplinary team to develop a pressure ulcer prevention program. CONCLUSION: The development of pressure ulcers is a painful, expensive, and unnecessary harm event that is all too prevalent in American hospitals. The prevention of pressure ulcers is a key intervention that is not new, not expensive, and has the potential to save thousands of patients from unnecessary harm.