Participation in a Pressure Ulcer Trial Increases Registered Nurses Awareness of Hospital Acquired Pressure Ulcer (HAPU) Ramifications

Topic: 

Annually, 2.5 million patients are treated in acute-care facilities for pressure ulcers. The average cost of treating a HAPU is $37,000. Critical Care patients area at a higher risk for HAPU development, with incidence ranging from 5.2-20%. The primary goal of this innovative teaching method was to demonstrate the importance of applied legal and ethical learning activities for critical care nurses related to skin care.

Purpose:

The primary goal of this innovative practice was to raise critical care nurses’ awareness of legal ramifications related to skin care.  Additional goals include: emphasis of the importance of completion of a skin and risk assessment every shift, accurate staging of pressure ulcers and improving skin care documentation.

 Objective:

The nursing department identified the need to make a practice change related to inconsistent pressure ulcer staging and skin care documentation.  The experiential learning occurred at the Critical Care Competency Fair and was based on a case study and mock pressure ulcer trial. The station consisted of three components and was supplemented by simulation that involved a patient who had developed a HAPU. Station components focused on legal aspects and concepts related to skin care and pressure ulcer development.  In the stimulation portion, each participant had to act as a fact witness, utilize a script and gave testimony before a judge. The testimony revealed inaccurate staging and documentation.  The final component involved the nurse acting as a jury member, analyzing key aspects and deciding a verdict in the case.

 Outcomes:

Participants (121) rated the activity as “exceeding expectations” or “outstanding”. Comments demonstrated that participants found the activity beneficial, enlightening and thought-provoking. Nursing leadership in critical care areas have witnessed an improvement in staging accuracy and the quality and completeness of documentation. Bi-weekly ICU skin rounds have shown improved staging and medical record documentation.