Increasing Pressure Ulcer Prevention specific to Braden Scale Sub-scores : A Quality Improvement Project

Pressure ulcer incidence is costly for healthcare facilities. One Midwestern hospital experienced three documented pressure ulcers in a calendar year. A quality improvement project to decrease hospital-acquired pressure ulcers was implemented using early pressure ulcer prevention interventions based upon the Braden Scale. The Quality Improvement Measure included two components; a mandatory online learning session and implementation of enhanced electronic documentation. Results for the study addressed the directional hypotheses :( 1) Registered nurses’ level of knowledge about pressure ulcer prevention interventions related to Braden Scale improved after a staff development session. Of the 396 nurses tested 67.42% were able to accurately identify a true statement about the Braden Scale before education was implemented. The pre-test demonstrated less than 50% understanding of the sub-scores sensory perception, activity and nutrition. Nurses’ ability to properly score a patient based on the Braden Scale indicated 23% of nurses were able to identify the case study patient who was at risk for a pressure ulcer.  After completion of the education module, nurses’ knowledge rose significantly to 94.24%.  (2) Documentation of pressure ulcer prevention increased in frequency after implementation of the mandatory staff education session. In at risk patients nutritional supplementation increased from 6 to 18 patients receiving additional nutrition.  . Likewise, moisture management increased from use in 11 patients to use for 19 patients. (3) The number of Pressure Ulcers’ was zero in the three month period after implementation of the enhanced electronic documentation and staff education session.A Pearson’s Chi Squared statistic did not show a significant difference in the use of prevention measures as the two groups were not equivalent in age or diagnoses.  The study also found that 11% of admission skin assessments were not completed on same day surgical patients whose status was changed to inpatient.