Skin Rounds: A Competency Validation for NPUAP Pressure Ulcer Staging & Assessment

Purpose:  Elevate the clinical practice of the Registered Nurse, ensuring accurate documentation of pressure ulcer staging and assessment; through the development and implementation of an evidence-based, hands-on 3 – Phase educational process to validate competency of the Clinical Registered Nurse utilizing NPUAP Staging System. 

Methodology:  A group of 10 Clinical Nurse Specialists (CNS) are dedicated to the professional development of the clinical nursing staff at 300+ bed Cardiac Specialty Acute Care facility.  CNS group provided with ongoing professional development in pressure ulcer staging and assessment through the CWOCN Specialist, without official competency validation.  Transfer of knowledge from the CNS group to the Clinical Registered Nurse was not consistently established.  Evidenced by documentation in the medical record, communication between caregivers and verbalized frustration in regards to utilizing NPUAP staging system.  

A Pressure Ulcer Staging and Assessment Competency Validation Tool was created, based on the NPUAP staging System.  Needs assessment:  Reviewing the needs and values of the learners, allowed the determination of type and extent of learning activities.  It was determined, a hands-on clinical experience would provide the appropriate climate for learning and best facilitate the adult learning process. This validation of competency accomplished through weekly visual skin rounds on all units in 3 distinct Phases utilizing a “Train the Trainer” approach.

Phase I:  CNS competency validation

Phase II:  Skin Champion competency validation

Phase III:  Clinical Registered Nurse competency validation

Statistics:  A PI checklist was developed to measure the clinical documentation improvements. Clinical Registered Nurse satisfaction was measured utilizing Shared Governance Survey.

Results:  85% of Clinical Registered Nurses Validated Competency

                 >90% PI Indicator measurement/compliance

                 Improved RN satisfaction with NPUAP Staging System

Conclusion:  The implementation of a competency validation tool for NPUAP staging improved the accuracy of pressure ulcer documentation and RN satisfaction related to documenting accurate stage and assessment of pressure ulcers.