Background

VA Medical Center- Washington, DC is a 197 acute care, 120 LTC facilities with 100 outpatient clinics. Staff did not consistently perform Braden Risk assessments and depended on the CWON to initiate prevention/treatment measures and existing preventive protocols. Average 2006 annual pressure ulcer incidence was 9% and documentation compliance was 66%. 

Purpose The CWON partnered with Nursing Leadership to reduce facility incidence, improve skin documentation compliance, preventive measures and pressure ulcer care.  

Objectives

 Based on results of a nursing knowledge survey the CWON would cultivate staff confidence through the following strategies:   

1. Educate nursing staff on risk assessment, preventive measures, products and support surfaces. 
2. Evaluate support surfaces and bed frames
3. Review skin assessment documentation
4. Provide mentoring and support through weekly skin rounds
5. Redefine the role of the unit-based skin care resource nurse
6. Weekly pressure ulcer tracking reports
7. Monthly multidisciplinary skin care committee meetings
8. Identify quality improvement opportunities

 Over a 6 month period, we will be implementing a pressure ulcer prevention program “Time to Turn”. Our program goal is to reach or exceed the national facility mean incidence of 7% and improve documentation compliance to 90%. The unit resource nurses have become empowered leaders and change champions along with increased facility-wide focus on reducing pressure ulcers.  The following strategies were implemented:

 Turn to reduce pressure

 Incontinence/Moisture Skin Protection Program

 Monitoring and Reporting chart audits and quarterly incidence survey  Education for staff Tracking Nosocomial Ulcers

 Observation and Documenting preventive measures

 Treatment per policy

 Utilize appropriate support surface

 Risk Assessment per protocol

 Nutrition is optimized -Caring Spoons feeding assistance program implemented

Conclusion

Reduction in pressure ulcer incidence can be achieved through a collaborative effort using education, action plans and monitoring of process measures and outcomes.