Hospital-Acquired Pressure Ulcers and Skin Care: Improving Nursing Staff Effectiveness

Purpose: Since patients’ skin condition reflects the quality of nursing care¹, a nursing initiative to decrease the prevalence of hospital-acquired pressure ulcers (HAPU) was implemented. Design: Descriptive, cross-sectional chart review with direct patient skin assessments. Sample: Convenience, 225 in-patients in two surveys. Method: The first survey conducted by a team of 31 nurses assessed 109 in-patients in November of 2007. Consents were obtained for direct skin assessments focusing on pressure ulcers of any stage and to review each patient’s chart for pressure ulcers on admission. The author implemented evidence-based strategies to reduce the prevalence of HAPU, which included the Braden scale², prevention interventions protocol¹, consultation requests for Nutrition Care and Wound Care Nurse³, a note to indicate if a pressure ulcer exists⁴, and the selection of a Pressure Ulcer Prevention Champion to implement these strategies through a hospital-wide training program⁵. The second survey of 116 in-patients was conducted 9 months after the strategies were implemented. Data analysis: Descriptive statistics. The number of HAPU is the difference between the number of observed patients with pressure ulcers and the number of patients with documented pressure ulcers on admission from the same sample. The prevalence of HAPU is the number of HAPU divided by the total survey sample⁵. Findings: The prevalence of HAPU in the first survey was 16%, and in the second survey was 8%. Conclusions: The strategies reduced the prevalence of HAPU by 50%. Implications: Military hospitals have a large number of young, otherwise healthy patients returning from the ongoing combat theater with complex injuries. High-quality nursing care improves patient outcomes by significantly reducing the risk of further complications. Further study is warranted into additional interventions based on skill-enhancing training for pressure ulcer prevention bundled with other nursing skill education focused on enhancing nursing quality of care indicators.