Pressure Ulcer Prevention Best Practice Team

Quarterly pressure ulcer prevalence monitoring has identified prevalence between 6% to 10% of patients. The focus of the interdisciplinary best practice team was to decrease this percentage and address prevention. The team represented nursing, pharmacy, physical therapy and nutrition. Nursing representatives included staff nurses, nurse managers, advanced practice nurses, and certified wound ostomy nurses. An extensive review of the literature was conducted. Based on the literature, it was found that staff education was the key to a thorough assessment and interventions to prevent skin breakdown. With the assistance of the nurse managers from each of the acute and critical care units, staff nurses were identified to be Skin Resource Nurses. These nurses were divided into teams to collect the quarterly pressure ulcer prevalence data. They were given extensive instruction on pressure ulcer staging and inter-rater reliability was established. In addition, these staff nurses assisted with the further education of staff nurses on the use of the Braden Scale to assess patients at risk of skin breakdown and to implement measures to prevent breakdown based on the Braden subscale assessment. When skin breakdown does occur, staff nurses have been instructed how to describe pressure ulcers identified using common terminology including location, depth, status of wound bed, and appearance of wound edges and surrounding skin. The team also worked with representatives from information systems. A report now is sent daily to nutrition indicating patients with low albumin enabling early treatment. An on-line incident report has been developed to facilitate early reporting of incidence of skin breakdown.