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Staff nurses were proficient in providing prompt and thorough skin assessments, and implementing standard and appropriate pressure ulcer prevention interventions, resulting in very low hospital-acquired pressure ulcer (HAPU) prevalence scores. However, the HAPUs that continued to occur were not those classically formed over vulnerable bony prominences.
Device-related pressure ulcers are distinctive from traditional pressure ulcers in cause and effect. Identifying unique risk factors and implementing prevention strategies required an adjustment in currently held nursing practice. Removing and repositioning medical devices, and averting skin breakdown, merited a fresh set of surveillance skills and staff education.
Method
Facilitated by the certified wound, ostomy and continence nurse (CWOCN), unit-based Skin Champions developed a quick and easy survey tool that captures device-related risk factors and guides implementation of effective preventive measures.
Scope
During weekly device-related pressure ulcer rounds, every patient is assessed from head to toe with focus on any and all medical devices that pose increased risk for skin breakdown. Vulnerable patients are identified. Skin Champs then collaborate with and educate staff in appropriate preventive measures, and those measures are then implemented.
Result
Within a one month, survey results showed less indication of delay in application of preventive measures by staff nurses, and, device-related HAPUs decreased hospital-wide. This trend continues today.
Conclusion
CWOCN facilitation, committed Skin Champ collaboration, and focused staff education, resulted in enhanced clinical practice and increased patient safety and outcomes.
Recommendation
During this process, additional areas of patient vulnerability, and need for additional staff education, have been distinguished. The CWOCN and Skin Champs have enhanced the device-related skin survey to include those areas of weakness and continue collaborate in this endeavor.