Background: Patients at extremely high risk for pressure ulcers and those with multiple pressure ulcers comprise a large component of the patient population admitted to a 404 bed acute care academic hospital in northwest Detroit. Nursing staff have identified low comfort levels with pressure ulcer staging and documentation in the electronic medical record (EMR).
Purpose: To decrease the number of hospital acquired pressure ulcers.
Objective: (1) To provide all patient care staff in emergency department and acute care areas of hospital with education about pressure ulcer staging and documentation. (2) Identify and eliminate barriers to documenting pressure ulcers in EMR.
Intervention: The WOC nurse team launched a hospital wide pressure ulcer reduction program focusing on improving pressure ulcer assessment and documentation. Mandatory education on pressure ulcer staging using the NDNQI online modules and unit based inservicing was completed with all nursing staff. Our EMR staff worked to improve the current electronic medical record to better meet the needs of the nurse at the bedside. This encompassed activating components of order sets and increasing space for pressure ulcer documentation. Laminated anatomical diagrams with common locations of pressure ulcers were mounted to unit computers to facilitate accurate documentation. The patient care associates (PCAs) had Lunch & Learn meetings where they too were educated regarding hygiene and pressure ulcer prevention.
Outcome: In April 2010 the WOC nurse saw 119 hospital acquired stage I, II, SDTI, and unstagable ulcers and 7 stage III or IV. In August of 2010, the numbers were reduced to 46 and 0 respectively; A reduction of 61%. Nurses indicated greater ease in identification and documentation of pressure ulcers. Since the intervention, staff have become more involved in pressure ulcer prevention.