Paper
Wednesday, 19 July 2006
This presentation is part of : Evidence-Based Decision Making: From Bedside to Boardroom
Using Evidence to Standardize Care Delivery Processes in At-Risk Patients
Nancy Freeland, RN, MS1, Cindy Berry, RN, BS2, Barry Evans, RN, MS1, Mary Comerford, RN, MS1, Michelle Atkinson, RN1, Amy Cioppa, RN1, Corinne Kiseleski, RN1, Holly Moynihan, RN1, Brenda Pavlik-McGowan, RN1, Lisa Wallin, RN, MS3, Cheri Witscheber, RN1, and Gail L. Ingersoll, EdD, FAAN2. (1) Critical Care Nursing, University of Rochester Medical Center, Rochester, NY, USA, (2) Nursing Practice, University of Rochester Medical Center, Rochester, NY, USA, (3) Adult Nursing, University of Rochester Medical Center, Rochester, NY, USA
The National Voluntary Consensus Standards includes pressure ulcers as an indicator reflective of nursing care quality. This indicator is highly relevant to acute care settings where patients are often at risk for developing pressure ulcers in response to patient-related and treatment-related actions or inactions. A review of one hospital’s quarterly pressure ulcer prevalence data determined the need for immediate action to bring the hospital’s rate to within acceptable levels for hospitals of comparable size and acuity. A multidisciplinary task force was convened to review the evidence concerning the best methods for preventing and treating pressure ulcers and to develop an evidence-based action plan based on findings. A decision was made to increase the frequency of pressure ulcer data collection from quarterly to weekly to better understand the types of patients developing ulcers and the methods used to manage ulcers once they occurred. A review of this data determined inconsistencies in the ways in which ulcers were managed within and across patient units. Data also demonstrated increased rates for patients admitted to highly specialized areas, with no evidence of extra precaution taken in these units. Using information obtained from a comprehensive review of the literature, task force members developed an evidence-based standard of practice, with an algorithm to assist in decision making and a revision to documentation forms to include increased attention to the measurement and management of ulcers. During the process, the task force reported several clinical impressions of patient risk factors not reported in the literature as contributory to ulcer development. As a result, a team of investigators initiated a retrospective medical record review to identify patient-related and treatment-related characteristics that contribute to the development of ulcers. Data collected through this review also were used to determine the effect of the revised standards of care on care delivery outcome.

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