PI15 2 RN Skin Assessment for the Prevention of Hospital Acquired Pressure Injuries

Candy Boyes, BSN, RN-BC, CWON, Wound/Ostomy (Clinical Resources), Mayo Clinic Hospital Arizona, Phoenix, AZ and Jane Sederstrom, MSN, APRN, AGCNS-BC, CCRN, Mayo Clinic Hospital Arizona, Phoenix, AZ
2 RN Skin Assessment for the Prevention of Hospital Acquired Pressure Injuries

Purpose/ Significance: Recent pressure injury (PI) prevalence and incidence reports have shown an increase in hospital acquired pressure injuries (HAPIs) at a local hospital in the Southwestern United States. Current practice included ongoing 1 RN skin assessments along with risk for PI as determined using the Braden scale. Despite this practice, the number of pressure related injuries continues to be greater than expected.

Current evidence supports thorough skin assessments for all patients.  While double check systems for nursing procedures have shown to improve outcomes.    

Description: In hospitalized adult patients, does a two RN skin assessment on every patient and every shift decrease hospital-acquired pressure injuries?

Methods:  Inpatient unit was selected as the pilot due to an increased incidence of HAPIs and the mixed acuity patient population.  Practice change was initiated which included a complete skin assessment performed by 2 RN’s on every patient and each shift. This included new admissions and transfers but was not limited to this group alone. 

Nursing education provided for performing complete skin assessments, pressure injury prevention strategies, and expectations. Bedside tools were placed in each patient room to help guide assessments.

Patient education booklets on pressure injury prevention were provided to patients on admission to promote satisfaction and to educate on the importance of 2 RN skin assessments in preventing skin injury. 

Results/ Evaluation: The number of HAPIs dramatically decreased during the pilot timeframe. The total number of HAPI’s dropped to zero within the first month of the practice change.  Consultations to the Wound/Ostomy team increased leading to earlier interventions for all concerning skin issues.

Implications for Practice: The 2 RN skin assessment increases accountability, therefore promoting quality patient care and makes the assessment of skin and prevention of injury a priority.