6213 Reorganization of Skin Team after Hurricane IKE

Catherine Walsh, RN, BSN, CWOCN, UTMB Health, Wound,Ostomy,Continence Nurse, Galveston, TX
Topic: Reorganization and redirection of a Skin Care Team to decrease pressure ulcer prevalence in a 427 bed academic medical center.

Purpose:  In 2008, the prevalence rate was 13%.  In September, 2008, Hurricane IKE closed the facility for 4 months.  The reopening of 200 beds offered the opportunity for new membership to revamp the structure and process to prevent pressure ulcers.

Objective: A multifaceted approach across an academic medical center was developed including expert practitioners collaborating with bedside clinicians on a weekly basis. An education plan was developed to improve documentation, prevention interventions, identification and staging of pressure ulcers, and treatment options. An evaluation plan and strategy to broadly disseminate the data was developed. The team was composed of critical care managers, clinical nurse specialists, geriatric nurse practitioner, nurse educators, WOCN, and sponsored by the director of adult patient care initially. Interdisciplinary involvement included respiratory therapists, physical therapists, emergency department, and perioperative clinicians. 

Strategies:

  • WOCN trained expert practitioners responsible for surveys.
  • Frequency of surveys increased from biannually to monthly. All identified wounds validated by WOCN as a pressure ulcer versus other wound types.
  • Optimized EMR capability.
  • Educational posters developed and disseminated in various formats.
  • NDNQI pressure ulcer training required annually of clinicians.
  • Weekly engagement of clinicians through skin assessment rounds, with focused coaching.
  • Daily posting of all pressure ulcers to managers and skin team.
  • A root cause analysis of each nosocomial pressure ulcers submitted to team chairpersons.
  • Trialed multiple mattress replacement types for patient and clinician satisfaction.
  • Dissemination of results from the organizational to unit level recognizing high performance.

Outcomes: Through restructuring the skin care team and diligence in identifying multifaceted opportunities, an academic medical center wide approach was implemented to decrease nosocomial pressure ulcers.  Pressure ulcer prevalence  decreased  to 5% in 2009 and 2% in 2011.