Benefits of engaging ICU staff nurses in pressure ulcer prevention

Skin Rounds were started by Wound CNS in 2008 for at risk Medical Surgical ICU patients in response to high incidence of nosocomial pressure ulcers (PrUs) in this population.  Skin Rounds were expanded to involve bedside RN working with Wound CNS, and later to pairs of bedside RNs conducting Skin Rounds in spring 2009.  After successful implementation as measured by early identification of problem areas, a decrease in development of nosocomial pressure ulcers, and an increase in staff satisfaction related to PrU prevention interventions, Skin Rounds were expanded in 2010 to include the Cardiothoracic ICU unit, and in 2011 to include the Bone Marrow Transplant unit.  All three units have nurses who serve as Wound Ostomy Resource Nurses to the hospital and have received special training to fulfill that role.  These nurses have demonstrated a strong commitment to pressure ulcer prevention and education for their colleagues and the patients they serve.

The peer to peer implementation of the skin rounds has been instrumental in early identification of barriers to interventions as well as problematic implementation of those interventions.  As staff nurses actively working on their respective units, they are able to witness firsthand the source of problems and barriers to success of current interventions and recommend process changes to eliminate identified barriers.  These RNs have been instrumental in identifying opportunities for improvement, have led product trials to find the most cost effective, easy to use interventions to prevent pressure ulcer development and then subsequently led the way to positive practice changes.

The work of these staff RNs has resulted in several benefits including a reduction in pressure ulcer development, specifically occipital, heel, and sacral/coccyx ulcer development, as well as a reduction in costs related to prevention interventions.    The resulting staff satisfaction has had tremendous impact on patient outcomes.