Utilization of Both Incidence and Prevalence to Guide Development and Maintenance of a Comprehensive Skin Wound Ostomy Team (S.W.O.T.) for Pressure Ulcers

In 2013, a multidisciplinary “SWOT” team was formed to improve patient outcomes by leveraging appropriate nursing staff and disseminating pertinent data regarding available skin, ostomy, and wound care products.   The institution has two Wound, Ostomy and Continence (WOC) nurses, seeing about 75 total inpatients and outpatients weekly.

 Our hospital is a 74 bed facility, including 12 ICU beds and 8 stem cell rooms.   The Director of Quality, Director of Nursing, and Senior Management supported the use of advanced skincare-educated nurses to provide education and standardization of products and protocols.  Led by the WOC nurses, monthly prevalence studies and daily incidence assessments were implemented to better track pressure ulcer rates within the hospital using a risk monitoring system.  SWOT is composed of two team-lead RNs, and 35 members from departments, including inpatient and outpatient clinics, and the Operating Room. Each nurse underwent a four-hour training course, spent a day with a WOC nurse, and conducts skin audits called “Wound Care Wednesdays”. 

SWOT reports high satisfaction with both their role as resources and assistance with competencies, and in their ability to improve a patient’s quality of life. Quarterly prevalence rates in 2013 were as high as 11%. Since the inception of the SWOT, incidence rates of pressure ulcers have remained low:  1.025% in 2014, and 1% for 2015.  As of November 2015, the prevalence rate is 0.4%. 

The implantation of daily incidence has improved transparency within our hospital and has been standardized throughout the entire organization. The last prevalence studies have showed zero hospital acquired pressure ulcers and with pay for performance increasing the ability to show better outcomes is paramount. The utilization of skin teams may be something all oncology hospitals may want to implement.