Impact of WOC Nurse Role on the Pressure Ulcer Rate in a Small Community Hospital

Topic: Is pressure ulcer prevention “Nursing 101” which every nurse knows how to provide? Or is a knowledgeable leader needed to provide specialized training and to lead  the team in efforts to prevent pressure ulcers?

Purpose/Objective: To demonstrate how the role of a certified wound care nurse enhanced the prevention programs in this suburban community hospital thus reducing the prevalence of nosocomial pressure ulcers.

Background: This hospital had been without a WOC nurse for nearly 2 years, but was using the Braden risk assessment and had prevention and treatment protocols still in place from the previous WOC nurse.  Nurses from the outpatient clinic would do occasional consults and run an annual prevalence survey. By December ’06 the nosocomial rate of stage 2 and greater pressure ulcers had soared to 23.7%. In March ’07 a CWCN was hired.

Process: The new CWCN became a member of the nursing leadership team, presenting monthly to the group and meeting as needed with the CNO and Quality Manager. Education was used to raise awareness of prevention and treatment and focused on admission skin assessments as well as nursing protocols. This was done in new hire orientation, unit meetings, formal inservices and 1 on 1 “teaching moments.”  Skin champions were mentored for each unit, receiving additional education both in house and off site. These teams were also taught how to do prevalence surveys and beginning in June ’07, monthly prevalence surveys were performed.

Outcomes: The nosocomial prevalence rate was 13.5% in June ’07, dropping to 5.3% by June ’08.  The rate of nosocomial pressure ulcers excluding stage I  dropped from 7.9% in June ’07 to 2.2% in June ’08.  Having a wound nurse provide education and coordinate process improvements has enhanced the patient care at this hospital as can be seen by these statistics.