Purpose/Objective

Pressure ulcers (PU) are considered to be nurse sensitive indicators. Estimates for the prevalence of pressure ulcers in acute care range from 10%-18% (National Pressure Ulcer Advisory Panel NPUAP 2001). Our suburban acute care hospital's prevalence numbers were in the high range of the national averages.  Improving our staff's ability to identify and prevent pressure ulcers became the focus of our “Year of the Skin”, an initiative driven by the Skin and Wound Resource Group (SWRG).

Method

Using NDNQI reports as benchmarks, they consulted our Nurse Research Scientist, reviewed recent literature, adopted NPUAP definitions and devised an Evidence-Based Skin at Risk algorithm using an “At Risk” Braden Scale score adjusted to 18 from 16. Based on suggestions from the SWRG, Clinical Informatics customized the Assessment screens, generating automatic referrals for “At Risk” scores. The SWRG completed NDNQI training. Mandatory skin education for nurses and therapists was created and the audit process was revised for efficiency and comprehensiveness. Our initiative was proclaimed on T-shirts and in news media.  

Four outcome measures monitored were: monthly PU prevalence rates by units; compliance with education; admission assessments completed within 24 hours; and perceived levels of confidence and empowerment of SWRG.

Outcome

Our numbers showed a precipitous drop in the prevalence of PUs from 14.8 to 1.1%. There was high compliance with skin education (90% to 93% for both modules). Compliance with risk assessments within 24 hours of admission rose from 54% in July 2006 to 99%. The SWRG perceived themselves as mostly (68%) or modestly (32%) confident in their role with empowerment gained from many sources most notably from their peers (84%) compared to from their manager (28%) or from the WOCN (16%).