Unit Based Skin Care Rounds Using the Braden Scale Sub-categories to Focus Nursing Interventions in Pressure Ulcer Prevention

The purpose of our rounds was to reduce the number of our hospital acquired pressure ulcers. Our goal was to help guide focused nursing based interventions to prevent pressure ulcer development.

Our objectives were to engage the bedside RN in active participation by verbally identifying areas of the Braden Scale sub-categories in which their patients were scoring low and to describe the nursing based interventions they could employ for pressure ulcer prevention. WOCN uses this time to provide “just-in-time” education to the bedside RN, help with pressure ulcer staging, offer suggestions on skin and wound care, use of equipment, coach RN in evidence based best practice for pressure ulcer prevention and proper scoring of Braden Scale sub-categories based on patient presentation.

Prior to performing Skin care rounds, our hospital acquired pressure ulcer prevalence rate was 6.3% for 4^th quarter 2009. After providing this type of 1:1 education beginning February 2010 our prevalence rate decreased to a low of 2.5% in 2 quarters. Bi-weekly rounds were performed on the nursing units which had the greatest prevalence rates (based on NDNQI quarterly reporting) using a team approach which includes the WOCN, the unit manager, the Skin and Wound Resource Team member for the unit and the unit based bedside RN. Nurses were asked to present their patient from a Braden Scale perspective focusing their report on the Braden Scale sub-categories and to identify nursing based interventions to address the sub-categories in which the patient scored low for pressure ulcer prevention. Our prevalence rates dropped in 2 quarters and the overall nursing knowledge has increased in pressure ulcer prevention techniques, pressure ulcer staging and management, skin and wound care products and equipment usage.