The Road to Quality in Pressure Ulcer Prevention

The Road to Quality in Prevention of Pressure Ulcers

 This is a journey WOCN’s may have faced when starting in a non-WOCN staffed facility, a high incidence of hospital acquired pressure ulcers and where to begin?  Two hospitals, as part of a larger system, faced this challenge. The hospitals did not have an inpatient WOCN overseeing  practices on a daily basis. Were there prevention measures being utilized? Did staff have a clear understanding of when to use prevention measures, how and on whom?

Planning for this task requires many steps taken over a period of time to achieve the best outcome. It may be a short road with quick fixes or a long road and slow fixes. The journey for these two hospitals turned out to be long and slow.

Starting with the basics, the WOCN reviewed policies, did daily chart reviews to assess current documentation practices related to prevention measures. Nursing staff were interviewed. What did they believe were the prevention measures needed to decrease hospital acquired pressure ulcers? Did they understand which prevention measures are required and who was at risk?

Daily rounds were performed by the WOCN on patients with an at risk assessment score. If the risk assessment scale was missing, rounds included alerting staff to perform a risk assessment. One on one discussion with a patient’s nurse and nursing assistant took place. A plan of care was discussed and implemented.

 Documentation of skin and risk assessments are now rarely missed. Prevention measures are routinely performed. Staff can verbalize prevention measures. Prevalence and incidence scores improved and the goal of decreasing hospital acquired pressure ulcers was achieved. The journey never ends in prevention of pressure ulcers. Staff  reminders and pulse checks are required to ensure the quality continues.