Hospitals in pursuit of excellence

Preventing Harm with the "6 Ps"

When Katherine Herrmann, the clinical quality facilitator at Henry Ford Health System, Detroit, was tasked with reducing preventable pressure ulcers and patient falls throughout the system, she didn't simply tackle each problem in isolation. Instead, Herrmann and her team created an improved nurse rounding program known as the "6 Ps" of patient care, or Pain, Personal Needs, Pulmonary Hygiene, Positions, Possessions and Place. Nurses perform duties designed to address the root causes of harm in each area every hour, marking a sundial-shaped board in each room to keep patients aware of their activities. The system reduced its pressure ulcer rate from 8 cases per 1,000 discharges in January 2008 to approximately three cases per 1,000 discharges by November 2009. Last year, three of the system's seven hospitals reduced patient falls 25 percent or more from 2008. Herrmann credits the results to the transformational changes in nursing culture.  "I really wanted to look at it from an integrated perspective, instead of having a falls team and a pressure ulcer team," Herrmann says.