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Wound/ skin care in our Children’s Hospital was fragmented and provided by a variety of individuals ranging from specialty nurse practitioners, other advanced practice nurses and physical therapy. Patient follow-up or outcome tracking was non-existent in the process. To address the various gaps in our wound /skin care, a comprehensive pediatric/ neonatal wound /skin program was developed to address the patient and staff needs in wound /skin care.
Pre- implementation analysis identified several areas for improvement. We found:
- Risk assessments were performed sporadically or absent. .
- Our pressure ulcer prevalence ranged from 10-30%. Patients were discharged with hospital acquired pressure ulcers
- Wound/ skin care guidelines were unavailable for bedside care providers.
- An analysis of staff nurse perception of baseline wound/skin knowledge level was reported as 6 / 10 on a Likert scale.
- The staff identified appropriate resources, but commented that there was no cohesive process or system for patient care.
Our “ SOS – Save Our Skin “ program included:
- Development of a Product Formulary: A standardization of skin and wound care products for the institution and each unit.
- Pressure Ulcer Prevention program to include education, risk assessments, surface management and CWOCN consultation
- Staff Education about pressure ulcer risk assessment and management, wound /skin care with special emphasis on the PICU and NICU ( highest risk / prevalence)
- Development of specific wound /skin care guidelines
- Establishment of skin resource teams in the NICU & PICU, with planned expansion institution-wide
- Family education complementing staff education topics
Program analysis demonstrated improvement in risk assessments, decreased prevalence in pressure ulcers, and in the overall wound/skin care for our patients. The staff identified improvement in wound /skin care knowledge and skills. This program also demonstrated the need for a CWOCN for the organization.