ABC'Skin

Hospital acquired pressure ulcer rates, benchmarked by NDNQI, were above national averages with documented delay in implementation of preventive interventions.  Policy interpretation was varied throughout diverse unit based practices. Electronic documentation failed to produce a clear connection between assessment and action.  Pressure ulcer prevention was perceived solely as a nursing responsibility within the organization.

The ABC'Skin project design elevated hospital wide awareness of pressure ulcer prevention promoting a culture of skin caring across the spectrum. The ABC'Skin strategies recognized skin with airway, breathing and circulation noting that “skin holds it all together.” Support staff, providers, leadership and all disciplines was identified as team members in reducing pressure ulcer risk. Strategies to create a skin caring culture were optimized. Nursing identified a need to connect pressure ulcer risk assessment with direct and time sensitive interventions. The addition of a skin care bundle provided an immediate documentation opportunity for an individualized plan of care based on a validated pressure ulcer risk assessment. The electronic record was redesigned to a “one stop” pressure ulcer prevention bundle directly associated with the risk assessment. The record incorporated hard stops and patient teaching.

After implementation of the pressure ulcer bundle, hospital acquired pressure ulcer rates as benchmarked by NDNQI, were reduced greater than 6% over six consecutive quarters. Unit acquired rates, including critical care areas, reached zero as evidence of sustained skin care caring culture practices.

Lessons learned from the ABC’Skin project included the critical importance of the impact of organizational culture, the value of team work and effect of hardwired nursing process on core outcomes.