Pressure Ulcer Prevention: Bringing Evidence-Based Nursing Practice to the Bedside

Kimberly Catania, MSN, RN, CNS, Cheryl Huang, MS, RN, CNS, Pauline James, MSN, RN, CNS, Michelle Madison, MS, RN, CNS, Molly Moran, MSN, RN, CNS, and Misty Ohr, MSN, RN, CNS. Aurthur G. James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH, USA

Bringing Evidence-Based Nursing Practice to the Bedside             Pressure ulcers in hospitalized patients represent a significant health care problem. Despite advances in modern technology and the array of preventative strategies available, the incidence of pressure ulcers continues to rise. In addition to the impact on patients and families and the significant financial burden on the health care system, pressure ulcer rates are viewed by the public as an indicator of the quality of care provided. Although pressure ulcer prevention is not solely a nursing responsibility nurses have the opportunity to significantly impact this problem. While nurses value the concept of pressure ulcer prevention and have adequate knowledge, prevention practices are inconsistent.               Evidence-based guidelines for pressure ulcer prevention programs focusing on risk assessment have been developed, however their existence does not ensure improved outcomes. While some of these programs have shown to decrease incidence, reduce care costs and demonstrate more effective use of resources, the incidence of pressure ulcers has continued to rise even with increased expenditures on these prevention programs. Successful implementation of evidence-based nursing initiatives need administrative support and available resources but ultimately will only have positive outcomes if there is buy-in from the staff at the bedside.
                    Pressure Ulcer Prevention Protocol Intervention (PUPPI) is an evidence-based nursing initiative developed using competencies for pressure ulcer prevention and treatment compiled by The National Pressure Ulcer Advisory Panel (NPUAP) Education Committee. These included risk assessment, skin assessment, individualized skin care programs, documentation, critical thinking and use of referrals as needed. Integration into practice focused on teamwork, communication and critical thinking to allow staff ownership and control for improving patient care and outcomes. Following implementation the pressure ulcer prevalence rate was reduced by 10% and has been maintained well below national benchmark for more than a year.

Learning Objective #1: Discuss key strategies needed to support successful implementation of evidence-based nursing initiatives.
Learning Objective #2: Explore the importance of bedside nursing support to create and evidence-based nursing environment.