Implementation of the Wound Treatment Associate Program in the ICU to Reduce Pressure Ulcers

In 2012, an analysis by the Patient Safety Committee of hospital acquired events, insurance carrier actuarial data, and Patient Safety Organization benchmarking studies revealed an increase in number and severity of Pressure ulcers (PU), inconsistent staging and documentation, and poor skin assessment in two critical care areas. The primary aim of this research study was to evaluate the impact providing nurses advanced training on the prevention of PU’s would have on early recognition and treatment of pressure ulcers. Another aim of the research study was to evaluate daily skin assessments performed by specially trained nurses would result in a decreased occurrence of avoidable PU's. Eight critical care nurses received training by attending the Wound Treatment Associate (WTA) program for three months. The program is endorsed by the Wound Ostomy Continence Nurses Society. The WTA program enabled nurses to assist with daily patient monitoring, pressure ulcer prevention, and basic wound management under the direction of a certified wound care nurse. The WTA's performed skin assessments every 24 hours on all eligible patients in the critical care units. During the three month project, skin breakdown was noted on a bedside tracking tool and a consult was placed to the wound care team. The pressure ulcers decreased from 18 to 1 in the SICU and 22 to 6 in the MICU. Early identification and treatment of pressure ulcers resulted in 19% of pressure ulcers and moisture lesions healing prior to transfer to the step down units. Daily skin assessments resulted in early recognition, documentation and treatment of skin breakdown. The project led to the resolution of suspected deep tissue injury and stage 1 ulcers preventing advancement to a higher stage and developing an early treatment plan for those pressure ulcers stage 2 or higher, which also resulted in increased healing.