Enhancing Quality, Expertise, and Evidence-Based Practice:

Joy Pittman, PhD, ANP-BC, FNP-BC, CWOCN, Wound Ostomy Continence, Indiana University Health, Indianapolis, IN and Judith Mosier, MS, MSN, RN, CWOCN, Wound Ostomy Continence Team Methodist, Indiana University Health Methodist, Indianapolis, IN
With increasing demands to improve efficiencies, promote quality care, and prevent pressure ulcers, direct care pressure injury prevention (PIP) expertise is necessary. The Wound Treatment Associate (WTA) program was identified as one method to build unit-level expertise and to enhance PIP strategies. The purpose of this project was to enhance nursing involvement in PIP initiatives, augment unit level PIP evidence-based practice, and decrease HAPI rates.

The WTA program was offered to nurses across a large Midwestern healthcare organization and the community. Following completion of the WTA program, nurses were encouraged to develop an evidence-based practice (EBP) project. 145 nurses participated in the WTA program from acute care, long term acute care, and skilled nursing facilities across Indiana 2013-2016. Specifically, 100 nurses from nine facilities participated with a 100% passing rate. Four WTA EBP projects were implemented and presented at the organization’s 2014 research conference. Ten WTA EBP projects were implemented in 2016.  Eight of the WTA graduates pursued WOC education to become certified WOC nurses.

Hospital acquired pressure injury (HAPI) rates decreased from 2.8% (2013) to 1.8% (2014) (p= 0.006) with continued decline to 1.15%.  There were 30 less HAPI per year and a 54% reduction in device related injury.  State reportable events reduced from 3 (2012), to 0 (2013) events and 1 (2014) event with a potential savings of $140,000. However, in 2015, with an increase in nursing turnover, novice nurses, and organization restructuring, sustaining HAPI improvement has been challenging. With the initiation of a second WTA cohort, 2016 HAPI rates have begun to decline with mean rate of 1.51% and no state reportable pressure ulcers to date.

The WTA program demonstrated positive results through engaging direct care nurse involvement in pressure injury prevention (PIP) initiatives, increasing PIP EBP initiatives at unit level, and decreasing HAPI rates.