AHRQ Pressure Prevention

Angie Szumlinski Featured

This is not a new tool and was developed for hospitals however the tools may be helpful if you are currently working on developing or improving your pressure reduction, skin integrity program.

Pressure ulcer prevention requires an interdisciplinary approach to care. Some parts of pressure ulcer prevention care are highly routinized, but care must also be tailored to the specific risk profile of each patient. No individual clinician working alone, regardless of how talented, can prevent all pressure ulcers from developing. Rather, pressure ulcer prevention requires activities among many individuals, including the multiple disciplines and multiple teams involved in developing and implementing the care plan. To accomplish this coordination, high-quality prevention requires an organizational culture and operational practices that promote teamwork and communication, as well as individual expertise. Therefore, improvement in pressure ulcer prevention calls for a system focus to make needed changes.

Toolkit Designed for Multiple Audiences

The aim of this toolkit is to assist hospital staff in implementing effective pressure ulcer prevention practices. The toolkit was developed under a contract with the Agency for Healthcare Research and Quality through the ACTION program (Accelerating Change and Transformation in Organizations and Networks), with additional support from the Health Services Research and Development Service of the Department of Veterans Affairs. It was created by a core team with expertise in pressure ulcers and organizational change at the Boston University School of Public Health. An expert advisory panel and quality improvement teams at six participating medical centers provided input.

The toolkit’s content draw on literature on best practices in pressure ulcer prevention and includes both validated and newly developed tools. The toolkit was tested in the six participating medical centers. Their feedback influenced this final version and their experiences are reflected in many of the examples provided.

The toolkit is designed for multiple uses. The core document is an implementation guide organized under six major questions intended to be used primarily by the Implementation Team charged with leading the effort to plan and put the new prevention strategies into practice. Because the guide is too long to be read by everyone, the toolkit includes a one-page pressure ulcer prevention implementation highlights to introduce the project to other key players, such as hospital senior management and unit nurse managers. This highlights tool can be found here.

The full guide also includes links to tools and resources found in the Tools and Resources section of the toolkit, on the Web or in the literature. The tools and resources are designed to be used by different audiences and for different purposes, as indicated in the guide.

Preventing Pressure Ulcers in Hospitals (Agency for Healthcare Research and Quality)