Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Kristen L. Mauk


Over 1.3 million persons are residents in nursing homes (NHs); one in ten have pressure ulcers. The purpose of this evidence based practice project was to determine if implementation of a pressure ulcer prevention tool, along with staff education, decreases the incidence of pressure ulcers within the NH. Florence Nightingale’s Environmental Model and the Stetler Model were used to guide this project. The setting was a NH in northwest Indiana. Eleven nurses attended a 15 minute educational session on pressure ulcer prevention and implementation of the Pressure Ulcer Prevention Protocol Intervention (PUPPI) tool. PowerPoint slides were distributed and flyers about the PUPPI tool were posted. The PUPPI tool consists of several areas: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The tool was utilized three times a week for 12 weeks, in addition to current practice, for patients with a Braden score of 18 or below. Pressure ulcer rates were collected four month retrospectively, during the intervention, and two months post intervention. Analysis of data was done using descriptive statistics with SPSS and Microsoft Excel. Two months post-intervention, total pressure ulcers rates (n=40) were considerably different from 2014 (n=58) showing a positive outcome with a downward trend in rates of wounds. Stage IV pressure ulcers from 2014 showed a significant decrease two months post-intervention (t(4)=3.333, p<0.05). There was a statistically significant decrease by 50% in facility acquired pressure ulcers from to 2014 (n=18) to two months post-intervention (n=9) (t(3)=2.306, p<0.05). Also, the total number of patients with facility acquired pressure ulcers were statistically significant decreased from 2014 (n=16) by over 50% two months post-intervention (n=7) (t(3)=3.220, p<0.05). The relationship between 2014 (r(39)=.296, p>.05) Braden scores and albumin levels and two months post (r(39)=.282, p>.05) showed a weak correlation with no significance. All participants who completed the post intervention survey (n=8) felt the educational session and the PUPPI tool were beneficial to pressure ulcer prevention, with the majority recommending adding the tool to daily practice. Prevention of pressure ulcers with protocols, education, and assessment tools, improves patient outcomes with a decrease in the incidence of pressures ulcers.