Standardized Communication during Hospital Discharge for Patients with Pressure Skin Injury

Purpose: To examine effectiveness of standardized electronic discharge instructions and wound care orders on wound healing outcomes during transition from acute care to home.

Method: This was a quasi-experimental, non-equivalent retrospective control group (n = 12) and prospective intervention group (n = 9) design pilot study of cognitively intact adult patients hospitalized in the Midwestern United States with a stage 2 or higher pressure injury who were discharged to home care services. We implemented an adapted, standardized, electronic version of the Project RED discharge wound care order set to improve communication about discharge wound care orders between physicians, wound care nurses, and home health nurses. Medical records of 20 patients were reviewed prior to implementation of the change; only 12 contained sufficient documentation for analysis. Nine records were reviewed post-change. The Pressure Ulcer Scale of Healing (PUSH) tool was used to evaluate wound healing.

Results: Time to initiation of treatment improved from 2.4 days for the control group to 1.6 days for the intervention group. Missing documentation by home health nurses made it difficult to evaluate wound healing in the pre-treatment group, as 73% of all wound measurements were missing from the documentation. Use of the wound care order set resulted in 100% compliance with written wound care discharge orders and 92% of discharge instructions; no statistically significant difference existed between control and intervention groups’ PUSH scores for any post-discharge measurements or 30-day readmission rates.

Conclusions:  Implementation of the standardized wound care order set and discharge instructions decreased the time to initial wound care treatment in the home and improved compliance with care orders. Home care nurses need to elevate their practice with consistent wound assessments and documentation, improving patient outcomes. Further research is necessary to test the use of the PUSH tool and its assessment of wound healing.