Knowledge & Understanding: The Necessary Link for the Bedside Nurse to Accurately Identify and Prevent Pressure Ulcers

In today’s quality focused healthcare environments, direct care providers need to be involved in reviewing their practice.  One facility was tracking and reporting pressure ulcer (PU) incident rates but detailed information was lacking. The purpose of this abstract is to describe the process change used in a Midwest academic medical center in PU evaluation. The project objective was to decrease PUs through active participation and education of nurses. Thus, the ICU developed and piloted a drill-down form to collect additional data on PU.  Once finalized, the form was shared with the house-wide PU prevention committee (PUPPI) and individualized for other patient care areas.

When a PU is identified, the nurse completes an assessment, implements a treatment plan, and orders a CWOCN consult.  The unit-based skin care nurse completes a drill-down form which is forwarded to a group of two CNSs, a certified wound nurse, and a nurse researcher.  Trends are identified and shared with PUPPI, an interdisciplinary committee encompassing staff nurses from all clinical areas and representatives from other disciplines. PUPPI is integral to disseminating information and identifying gaps in education and nursing practice related to PU prevention.

Weekly rounds by unit skin representatives and CWOCN were implemented on several acute care units. Preventative actions are taken immediately on all at-risk patients, resulting in early recognition and prevention of PUs. Staff education is incorporated at the bedside during rounds.  Weekly communication and feedback resulted in quality outcomes: a downtrend trend line for all units for unit acquired PU.

Nursing administration has recognized the benefits of having direct caregivers involved in the quality review process.  Active participation of direct care staff has led to an increase in knowledge and understanding in the process of identifying risk and preventing PU.