Karen J. Riemenschneider, RNC, MS, CWOCN, Albany Medical Center, Clinical Nurse Specialist, 43 New Scotland Ave., Albany, NY 12208
Purpose: To reduce the number of facility-acquired pressure ulcers and improve compliance with skin integrity documenation on a medical unit. Objective: To use mentorship as the foundation for development of a unit based pressure ulcer prevention plan. Most staff could confidently, but not consistently, perform the Braden Risk assessment. They were overly dependent on the CWOCN for decisions about pressure ulcer prevention and hesitant to proactively initiate existing preventive protocols and algorithms. The CWOCN partnerned with the the Assistant Nurse Manager(ANM)and through this empowerment, the ANM became the "change champion" for this unit. To cultivate staff confidence, the following strategies were employed as foundation for this unit based plan: Education was provided by the CWOCN in the form of lecture, discussion, and demonstration and return demonstration with emphasis on preventive strategies. Initiation of weekly skin rounds with the ANM and CWOCN provided the ANM with mentoring and, at the same time, staff support and the ability to review documentation. Monthly unit pressure ulcer prevalence rates and documentation compliance was shared as a means to trend progress and to identify opportunities for improvement. Outcome: As a consequence of the ANM mentoring, she and her staff rapidly integrated pressure ulcer prevention strategies into their daily practice. This resulted in a decrease of the unit's facility acquired pressure ulcer prevalence rate from 18.5% to 3.8% over a 7 month period. Documentation compliance also improved in this period from 50% to 86%. An unanticipated, serendipitous outcome from this clinical practice project resulted in the enpowerment of the ANM in her abilities as the clinical resource and change champion on this unit. This successful endeavor lead to hospital wide adoption, and within one year, using this same model, all the ANMs have become the clinical resources and change champions for each of their perspective units.
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See more of The WOCN Society 39th Annual Conference (June 9 -- 13, 2007)