Paul Rohini, McCutcheon Stacey Paris, Tregarthen Jenna Penelope, Denend Lyn Thayer, Zenios Stefanos A
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,
Am J Nurs. 2014 Aug;114(8):34-44; quiz 45-6. doi: 10.1097/01.NAJ.0000453041.16371.16.
\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.
印度班加罗尔的纳拉亚纳心脏医院（NHCH，现称为纳拉亚纳心脏科学研究所）是世界上规模最大、最繁忙的心脏医院之一。2009年初，NHCH实施的外科手术数量急剧增加，医院获得性压疮也相应增多。该医院试图通过实施一系列质量改进策略来降低压疮发生率。基线数据显示，在为期五个月的观察期内，NHCH重症监护病房（ITU）中，所有成年和儿科手术患者在康复过程中平均有6%发生了压疮。2010年1月开始的第一阶段实施工作集中在四个方面：提高认识、加强教育、改善记录与沟通以及实施各种预防措施。次月开始的第二阶段实施工作重点是改变手术室操作规范。主要结局指标是ITU中发生压疮的患者每周所占的百分比。到2010年7月，该百分比降至零；截至2014年4月1日，医院一直保持这一成果。对该项目的成功和可持续性有显著贡献的因素包括强有力的领导、护士和医生的参与、对个人责任的强调、记录与沟通的改善、持续的培训与支持，以及对核心工作流程和行为的一系列低技术变革。其中许多因素适用于美国的急性护理环境。
