Epilepsy Monitoring Unit achieves patient safety milestone in HAPU prevention

November 17, 2015


The Epilepsy Monitoring Unit (EMU) had one hospital-acquired pressure ulcer (HAPU) in a period of 892 days, which translates to 647 days and 244 days without a HAPU occurrence. These notable milestones demonstrate the value of teamwork and commitment to cultivating an environment of safe patient care.

When epilepsy patients are admitted to the EMU for an electroencephalography (EEG) study, electrodes are attached to their scalp, forehead and cheeks. These electrodes, which enable the recording of brain wave activity to diagnose seizures and other neurological disorders, can lead to skin breakdown at the electrode sites resulting in a pressure ulcer.

“Before revising our quality improvement practices for HAPU prevention, 10 percent of our EMU patients developed a HAPU, averaging three or four occurrences per month,” Texas Children’s Clinical Specialist Joellan Mullen said. “Today, we have brought our HAPU incidence rate to zero.”

In an effort to reach this milestone, EMU nurses, technicians, physicians and physician assistants collaborated to develop techniques to enhance skin care management and pressure ulcer prevention. These best practices were published in the 2014 issue of the Journal of Pediatric Nursing co-authored by Mullen and Texas Children’s EMU/EEG Clinical Manager Wendy Morton.

Several improvements were implemented to reduce HAPUs:

  • Patients were prepped with a less abrasive solution to remove oils from the skin before electrodes were placed on the scalp and forehead
  • Disposable electrodes were used to reduce the potential risk of infection instead of using the same electrodes for patients following equipment disinfection
  • Crib mattresses were replaced with pressure-reducing cushions to distribute weight evenly
  • A breathable, fishnet dressing was wrapped around the electrodes on a patient’s head to prevent moisture and pressure on the scalp. Prior to this change, the entire head was wrapped tightly in gauze which increased the potential of skin breakdown at the electrode sites.
  • Wireless technology was implemented to allow greater mobility for patients. Instead of being tethered to the wall, the electrodes are hooked up to a small monitor that patients wear as a backpack so they can move freely in the unit instead of being confined to the bed.
  • Nurses performed skin assessments for pressure ulcers twice per shift – before the electrodes were placed on the patient and after they were removed.

Additionally, the Skin Champions Program helped staff significantly reduce the occurrence of pressure ulcers in the EMU and in high acuity areas of the hospital like the intensive care and cardiovascular units.

Two skin champions were chosen from each unit to serve as coaches and ensure compliance with proven pressure ulcer prevention strategies. While all EMU staff members are trained in HAPU prevention, skin champions undergo more intensive training and must attend monthly educational sessions with a certified wound-ostomy nurse.

“Ensuring our nurses and technicians are equipped with the knowledge and tools to take preventive action are key to creating a harm-free environment for our EMU patients,” Mullen said. “I am proud of our team for helping us achieve this milestone.”