6230 Skin Deep: A Quality Improvement Project to Improve Wound Care Documentation and Hospital-Acquired Pressure Ulcers

Diane M. Holland, RN, MS, CWON, Highland Hospital, CNS, CWON, Rochester, NY
Background: The medical record is a communication tool for caregivers. Careful documentation helps identify the condition of the skin and assess progress with wound healing. The medical record must reflect the therapies that are instituted to prevent pressure ulcers.  With the Center for Medicaid Services changes in 2008, hospital-acquired pressure ulcers will not be reimbursed by most insurances.1  Therefore, it is important to document the skin assessment on admission and pressure ulcer prevention measures.

Objective: To determine whether an educational initiative on wound documentation can improve the incidence of hospital-acquired pressure ulcers.

Method: In a mid-size hospital in upstate New York, a step-down unit with a higher than benchmark rates for HAPU was chosen. Several areas of documentation were identified for improvement. These included:  wound staging, admission documentation and turning documentation. A care-learning program on wound staging was completed by staff.  A “Wound Wednesday” sheet was developed.  The wound sheets were reviewed by the charge nurse and the CWOCN weekly.

Results:  The educational programs and the wound Wednesday sheets have been successful in focusing wound documentation. Since the program, we have seen a decrease in hospital-acquired pressure ulcers. The step-down unit has maintained pressure ulcer rates below the NDNQI benchmark for over one year.

Discussion:  Focusing on admission documentation and weekly notes about wound care allowed us to see which wounds were present on admission and which developed later. Skin conditions such as incontinence associated dermatitis (IAD) and hydradenitis suppurativa which can be mistaken for pressure ulcers were identified for staff.  Feedback helped to clarify wound staging, etiology and documentation. The lower rates of hospital-acquired pressure ulcers may be related to improved documentation and our renewed focus on preventive care documentation.  We plan to expand this program as we move to an electronic record.