Back to the Basics: WOC Nurses Quality Initiative to Improve Accuracy of Staging Pressure Injuries

Every registered nurse learned how to properly stage pressure injuries according to the National Pressure Ulcer Advisory Panel guidelines in their nursing school curriculum. Applying that knowledge in everyday practice on a consistent basis was found to be problematic for the nurses at this large, southeast academic hospital. Nurses faced two main challenges. First challenge was erroneously staging wounds that were not caused by pressure. In addition, wounds caused by pressure were misclassified. Without proper identification and staging of wounds, a prompt and effective plan of care for patients with pressure injuries cannot occur. Facility acquired pressure injuries have ominous implications for the patient and hospital. Increased patient morbidity and medical costs for the patient; and erroneous benchmarking, reimbursement, and legal issues for the hospital are just some of the implications. The WOC nurses job was to go back to the basics and retrain 2500 nurses. 

     The WOC nurses, recognizing the importance of correct staging, developed a reliable staging algorithm for the nurses to use during monthly prevalence. Even the unit OWLs (Ostomy, Wound Liaisons), who are specially trained in wounds and ostomies, had many issues with identifying and staging pressure injuries accurately. The average accuracy rate for these specially trained nurses from February to July in 2015 was 84%. The accuracy rate goal was 90% or higher. The Pressure Ulcer Algorithm was taught to these specially trained nurses as an adjunctive tool to use during monthly prevalence. After implementing this tool for six months, the accuracy rate of staging improved by 14%. The Algorithm was concluded to be an effective tool for nurses to correctly and accurately identify and stage pressure injuries. The Algorithm will be incorporated into the electronic medical record for all nurses to use at this facility.