A Standardized Approach to an Admission Skin Assessment

In 2011, the hospital-acquired pressure ulcer prevalence rate at a large Midwestern Academic Medical Center averaged 4.42% compared to the national benchmark average of 2.35%. With the higher than benchmark averages the WOC nurse team decided to complete a root-cause analysis of the numbers. One thing that was discovered was there were no standards for skin assessment and documentation on hospital admissions. This lead to the possible conclusion that some of the pressure ulcers being reported as hospital acquired were actually community acquired.  In March 2013, the WOC nursing team implemented the 2 Registered Nurse (RN) or “4 Eyes on Skin” assessment on all admissions and unit transfers. Using an electronic medical record, any skin issues and/or pressure ulcers were documented and signed off by two Registered Nurses. The outcomes were positive with a downward trend in prevalence. Since 2013 the 2 RN skin assessment has become a standard of care that has spread through the hospital enterprise. In 2013, the pressure ulcer prevalence rate was 1.47% and has remained under the benchmark number to date, which can be attributed in part to the implementation of the 2 RN admission skin assessment.