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Purpose: The purpose was to create a nursing protocol for clinical staff, at a Catholic Regional Level II Trauma Center in the Midwest, to independently implement evidence based skin care and improve workflow for the Certified Wound Ostomy Continence Nurse (CWOCN). Over a three week period the CWOCNs received a total of 292 new inpatients consults. Upon evaluation of the received consults, 19% for skin folds, 8% for incontinence dermatitis, 6% for skin tears, and 6% for blanchable erythema.
Interventions: An evidence based electronic nursing protocol was created to define treatment recommendations for the following conditions: incontinence dermatitis, skin tears, skin folds, blanchable erythema, suspected deep tissue injury, Stage 1-4 and unstagable pressure ulcers, and ostomy needs. The pressure ulcer and ostomy needs prompt clinical staff to immediately enter a CWOCN consult. The remaining conditions are defined and include specific treatment recommendations for immediate implementation. Interventions include preventative measures, cleansing requirements, creams, powders, and dressings. The protocol also indicates that a CWOCN consult is necessary if the interventions are not effectively improving the identified condition. Staff education was completed via posters (included photos of the skin conditions), computer based training, newsletter articles, and 1:1 colleague follow up by department Skin Champions. Pocket cards, that included photos of the conditions, were also created and available for use.
Results: A six month post implementation review was conducted. Over a three week period the CWOCNs received a total of 213 new inpatients consults. Upon evaluation of the received consults 4% for skin folds, 1% for incontinence dermatitis, 3% for skin tears, and 3% for blanchable erythema. Overall there has been a 27% reduction in CWOCN consults related to skin care needs that can be treated or prevented independently by the clinical staff.