Cultural Transformation in Pressure Ulcer Prevention and Care

Cultural transformation was the impetus for the creation of the Wound Care Program at Veterans Affairs Hospital in Northport, New York.  An organization must be aware of the need for change based upon a reflection of current behaviors, practices, and processes in place.  These cultural "norms" may have to be altered based upon the facilities desired outcomes.  A review of the previous practice showed that the Wound Care Nurse was the only one responsible for the patient's skin integrity, with the role being limited to acute care only.  The campus consists of 134 bed long term care, 121 acute care, and 50 outpatient clinics.  As well as limited access to the specialist, care was fragmented, with skin and wound products available to inpatients only.  The facility provided one form of low air loss therapy for its inpatients, but the Wound Care Nurse was the only one able to order these surfaces.  The goals of the institution were to establish a cultural change with distinctly different set of results.  The desired effect was to engage the staff, improve clinical outcomes, and establish an evidence-based wound care program for the veterans it serves.  The outcomes obtained resulted in a significant decline in facility-acquired pressure ulcers, as well as implementing autonomy in the nurse's role of preventative skin care.  Reframing the role of Wound Care was seen as a valuable opportunity to expand our engagement with the patients.