What Do PUPPs and SKIN Have in Common? A Multidisciplinary Approach To Documentation Improvements

Carol Hall, BSN, RN, CWOCN, U.T. Southwestern Hospital at Zale Lipshy, WOCN, Dallas, TX, Claudia Engle, RN, CWOCN, CFCN, WOC nursing, UT Southwestern at Clements University Hospital, Dallas, TX and Emily Flahaven, MSN RN CAHIMS, Infomatics, UT Southwestern, Dallas, TX
BACKGROUND:  The hospital electronic skin documentation changed leading to confusion and dissociation of care of patients with pressure injuries. A housewide survey showed that staff were no longer receiving education regarding staging of pressure ulcers and were inconsistent regarding documentation of skin problems.

METHODS:  A skin documentation multidisciplinary task force was formed in April 2016 to meet weekly to evaluate the existing skin documentation and to make recommendations for change.  One goal was the review of best practices in skin documentation, nursing interventions, and standing medical orders as well as to develop a plan for implementation.  A skin bundle for pressure ulcer prevention was developed which included a best practice alert within documentation for any patient with a Braden score of 18 or below.  A clinical pathway was streamlined to guide nursing staff for treatment of pressure ulcers, skin tears, and moisture associated dermatitis.

RESULTS:  Education was created with a go-live date of 9/19/16 including classes designed to review pressure ulcer staging, treatment and documentation--these were mandatory for skin representatives and assistant nurse managers.  Two skin reps were assigned from each unit to be skin champions and superusers for documentation.  Pressure ulcer staging modules and testing within the electronic training program were mandatory for ALL nursing staff.  In conjunction with the skin documentation being revised, the event reporting system was revamped to include a debriefing tool for any hospital acquired pressure ulcer to determine causes and if further prevention methods should be developed.