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A Clinical Nurse Specialist–Led Interprofessional Quality Improvement Project to Reduce Hospital-Acquired Pressure Ulcers

Fabbruzzo-Cota, Christina MN, RN CON(C); Frecea, Monica MScN, RN, CETN(C); Kozell, Kathryn MScN, RN, CETN(C); Pere, Katalin MN, RN, CCN(C), APCF; Thompson, Tamara PTA/OTA; Tjan Thomas, Julie RN, MN, CETN(C); Wong, Angela MScOTReg. (Ont.)

doi: 10.1097/NUR.0000000000000191
Feature Article

Purpose: The purpose of this clinical nurse specialist–led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice.

Background: Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings.

Rationale: Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital’s (MSH’s) mission and vision, which mandates providing the highest quality care to patients and families.

Description: This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses’ Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization.

Outcome: An 80% decrease in HAPUs has been achieved since the implementation of best practices by the Best Practice Guideline Pressure Ulcer working group.

Conclusion: The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication.

Implications: This quality improvement project is a successful example of an interprofessional clinical nurse specialist–led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.

Author Affiliations: Clinical Nurse Specialist–Sarcoma (Ms Fabbruzzo-Cota); Clinical Nurse Specialist, Enterostomal Therapy Department (Mss Frecea and Thomas); Clinical Nurse Specialist/Manager, Rachel Flood Education Program (Ms Kozell); Clinical Nurse Specialist, Medicine and Cardiology (Ms Pere); Physiotherapist Assistant and Occupational Therapist Assistant (Ms Thompson); Occupational Therapist (Ms Wong), Mount Sinai Hospital, Toronto, Ontario, Canada.

This work is part of the Best Practice Spotlight Organization Initiative, funded by the Ontario Ministry of Health and Long-term Care. For more information about the Registered Nurses’ Association of Ontario Best Practice Spotlight Organization Initiative, please visit

The authors report no conflicts of interest.

Correspondence: Monica Frecea, MScN, RN, CETN(C), Mount Sinai Hospital, 600 University Avenue, Room 1401C, Toronto, Ontario, Canada M5G 1X5 (

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