Pressure Ulcer Prevention Program: Multidisciplinary Team Approach using an Evidenced Based and Action Oriented Process

Pressure Ulcer Prevention Program: Multidisciplinary Team Approach using an Evidenced Based and Action Oriented Process

Tillie Maria Jones, BS, RN, CWOCN

Patricia Zielinski, BSN, RN, WCC

Marianne Kraemer, BSN, RN, MPA, ED. M, CCRN, NE-BC

Prior to 2006 Kennedy University Hospital’s acquired pressure ulcer rate was above the national benchmark.  With the growing awareness of changes in reimbursement for hospital acquired pressure ulcers, nursing leadership recognized that assessment and care needed to be improved. Between 2006 and 2007 nursing leadership evaluated the pressure ulcer assessment, prevention and care program. The major findings discovered were the inadequacy of a yearly pressure ulcer prevalence and lack of staff knowledge and skill regarding pressure ulcer staging, prevention and care.

In 2007 multiple interventions were designed to address the deficits in Kennedy’s pressure ulcer prevention program. A literature search for best practices helped develop mandatory education for nursing staff.  Each of the three hospitals developed “Dermal Defense Teams” comprised of clinical nurses, educators, infection control practitioners, transport staff, physical therapists and pharmacists.   By early 2008 the Braden score was used to identify patients at risk. Evaluative studies were performed on the array of skin care products, bed and seating surfaces for best results and cost effectiveness. The Skin Care policy was updated and revised which included a process to empower clinical nurses to implement interventions and preventive measures based on pressure ulcer risk and skin assessments.  

Since 2008 other proactive advancements included interdisciplinary collaboration and increased visibility and availability of two full-time Wound Care Specialists. Dermal Defense Team members continue to participate in prevalence studies. The multifaceted approach to enhance pressure ulcer assessment, prevention and care is validated by a decrease in prevalence rates to 2.8% in 2008 and 1.73% in 2009. Preliminary metrics for 2010 continue to show progress to decrease pressure ulcer prevalence.