Sustainability of a skin prevention program on an acute care adult geriatric unit: A quality improvement project

The goal of this quality improvement project was to achieve a sustainable unit driven skin prevention initiative to eradicate unit acquired/ hospital acquired skin breakdown (HAPU) on an adult geriatric unit (ACES).   The implementation of a unit driven skin prevention program versus individual or WOCN staff lead programs is thought to facilitate improvement in HAPU outcomes by creating a culture of excellence among clinical staff.  Meetings with the ACES unit multidisciplinary team identified the need to strengthen clinical staff and provider knowledge regarding pressure ulcer risk assessment, interventions, and to improve current clinical practice and outcomes.  A review of the literature supported a multidisciplinary, patient centered, evidenced based approach to pressure ulcer prevention incorporating critical success factors. These factors surrounded clinical staff support, education, and allocation of resources. Support was provided by clinical leadership, the wound and ostomy practice and the unit nurse educator to implement weekly skin rounds.  A pre-intervention pressure ulcer knowledge survey was conducted and education was provided to staff including: Braden scoring, pressure ulcer assessment, and intervention.  Weekly surveys were conducted initially with the wound/ostomy program director, WOCN staff, and nurse educator with unit staff rotating as leads. Once clinical knowledge / assessment skills improved along with staff confidence the unit staff assumed independence as  leads, performing weekly skin assessments and  Braden assessments with peers.   Point prevalence data was collected and analyzed, the knowledge survey was repeated, and staff engagement /satisfaction survey was conducted.  Initial findings suggest improvement in point prevalence scores with decreased occurrence of HAPU, increased midpoint survey scores regarding staff knowledge of pressure ulcer assessment and interventions, and staff satisfaction surveys reflected positive attitudes /engagement in the process.  Facilitation and support of clinical leadership, resources, and staff has created sustainability of this unit driven skin prevention initiative