Pressure Ulcer Staging Algorithm: Implication to Bedside Nursing Practice

Pressure Ulcer Staging Algorithm: Implication to Bedside Nursing Practice

Changes in health policy (non- reimbursement for hospital acquired pressure ulcers) have increased the need for bedside nursing to accurately identify and document pressure ulcers.   According to Kelly and Isted (2011) only 56% of bedside nurses could accurately stage a pressure ulcer.  Inaccurate staging of pressure ulcers can be costly to hospitals.  According to The Wound, Ostomy, Continence Nurse Certification Board (WOCNCB), as of June of 2014, the number of certified WOC nurses was 6,100 (K. Meyer, staff WOCNCB personal communication, June 20, 2014) to fulfill the need of 920,829 hospital beds in the America (American Hospital Association, 2014).  To combat this issue it was decided to develop unit-based skin care teams to aide in pressure ulcer prevention and identification. The low percentage of staging accuracy from bedside nurses initiated the need for a staging algorithm that could by utilized by nurses at the bedside. There are many instruments in use that assist with staging, but there is a lack of evidence to aide in the support of the use of one versus another (Arndt & Kelechi).  Following a literature search an already established algorithm was not discovered for staging so one was created. The algorithm was incorporated into the monthly skin checks conducted by the skin care teams.  Nurses were able to use the algorithm when assessing the patient's skin and to assist in accurate staging of a pressure ulcer.  The nurses reported feeling more confident in their decision.  There was a positive response from the nurses with respect to ease of use.  The accuracy of staging, especially between stage II and III pressure ulcers increased.  This is significant with regards to non-reimbursable hospital acquired pressure ulcers.