LASER Tool - Thinking outside the box: The use of simulation to competency nurses on accurate pressure ulcer assessment and documentation

Effective October 1, 2012 Long Term Acute Care Hospitals (LTCHs) began to submit pressure ulcer quality data to the Center for Medicare and Medicaid Services (CMS) on the quality measure – Percent of Residents with Pressure Ulcers that are New or Have Worsened and to collect supporting information that has the potential to effect pressure ulcers (i.e.; bed mobility, bowel incontinence, diagnoses, nutrition).With pressure ulcers now a universally recognized quality indicator, proper assessment and documentation demands attention by clinicians and with CMS. The LASER tool requires pressure ulcer data to be documented within day 2 of admission. With this requirement, it requires the clinician to stage and document a pressure ulcer at time of admission accurately since the WOC nurse is not always available during admission assessment. The challenge we faced was to competency all nurses on proper staging and documentation and how best to increase retention of the information learned. The decision was made to use simulation.  This allowed the WOC nurse to be present during the mandatory skills/competency day and be present during an admission skin/wound assessment utilizing a SimMan ®. The SimMan ® had pressure ulcers, along with other wound types (actual photographs) ironed on to a t-shirt, boxer briefs and socks. These wounds/pressure ulcers were located over anatomically correct locations.  Each nurse was required to complete a head to toe skin admission assessment, properly identifying the etiology and location of the wounds. During this assessment the hospital weekly documentation form was completed to assess accuracy of completion. The use of simulation allowed the WOC nurse to be present and use “on the spot” education. By using simulation and thinking outside the box, the nurses retained the information taught and on admission pressure ulcer and wound documentation improved resulting in accurate and timely Laser tool submission.