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Purpose: To engage the Perioperative Services (PS) in a hospital-wide pressure ulcer (PU) prevention program thus incorporating consistent safe practices throughout all nursing services.
Objective: In the anticipation of the Center for Medicare and Medicaid Service’s mandates regarding reimbursement rates for hospital acquired pressure ulcers (HAPUs), our hospital’s Quality Improvement department challenged the PS to become active participants in the institution’s skin and wound care program.
Outcomes: The immediate response by the PS staff was disbelief. We began a path of discovery and learning that has captivated the entire staff. This pathway, based on the Kubler-Ross’ “Stages of Grief,” was met with some degree of resistance that required an evidence-based rebuttal.
The stages:
1. The first stage was Disagreement: most nurses expressed doubt that the PS had anything to do with PU development.
2. The second stage was to Argue the point. Patients are in an OR for a few hours and not long enough to “cause” a PU.
3. Nurses then began to Struggle over adding an already heavy workload.
4. Concern soon overtook the focus for nurses who had been in the OR for years and had little knowledge of risk assessment, staging, treatment, and prevention of PU’s.
5. We developed an Action Plan incorporating a PU prevention “mind set” into members of the PS team.
To date the accomplishments are an education program, a newly developed documentation form, using the Braden Scale at key intervals of the perioperative process, identifying community-acquired PU’s, use of wrist bands to identify patients at high risk for postoperative PU formation due to prolonged surgery and/or positioning, and a Perioperative Newsletter that is distributed throughout the facility. PS has become part of the team, thus assisting in the endeavor of improving patient care.
Objective: In the anticipation of the Center for Medicare and Medicaid Service’s mandates regarding reimbursement rates for hospital acquired pressure ulcers (HAPUs), our hospital’s Quality Improvement department challenged the PS to become active participants in the institution’s skin and wound care program.
Outcomes: The immediate response by the PS staff was disbelief. We began a path of discovery and learning that has captivated the entire staff. This pathway, based on the Kubler-Ross’ “Stages of Grief,” was met with some degree of resistance that required an evidence-based rebuttal.
The stages:
1. The first stage was Disagreement: most nurses expressed doubt that the PS had anything to do with PU development.
2. The second stage was to Argue the point. Patients are in an OR for a few hours and not long enough to “cause” a PU.
3. Nurses then began to Struggle over adding an already heavy workload.
4. Concern soon overtook the focus for nurses who had been in the OR for years and had little knowledge of risk assessment, staging, treatment, and prevention of PU’s.
5. We developed an Action Plan incorporating a PU prevention “mind set” into members of the PS team.
To date the accomplishments are an education program, a newly developed documentation form, using the Braden Scale at key intervals of the perioperative process, identifying community-acquired PU’s, use of wrist bands to identify patients at high risk for postoperative PU formation due to prolonged surgery and/or positioning, and a Perioperative Newsletter that is distributed throughout the facility. PS has become part of the team, thus assisting in the endeavor of improving patient care.