The education session will provide relevant and current knowledge of how to implement a benchmarking prevalence and incidence study of a nursing sensitive indicator, pressure ulcers.

Educational Objectives:

1.  Define a standard process for monitoring a nosocomial pressure ulcer prevalence and incidence study on a quarterly basis in accordance with NDNQI guidelines. 

2.  Identify the steps of a systematic benchmarking approach including: recognizing performance gaps, putting a process in place, and monitoring and maintaining improved patient outcomes. 

The purposes of this educational session are to: (1) describe a process for determining the prevalence and incidence of hospital acquired pressure ulcers, and (2) to demonstrate a method to utilize a nursing sensitive indicator to improve patient outcomes.

Summary of presentation:

In a large Midwestern Medical Center the Advanced Practice Nurses (APN) and Clinical Practice Partners (CPP) are responsible for performing the quarterly prevalence and incidence studies.  Data abstraction teams incorporate staff at every level and across all units including, critical care, medical/surgical and rehabilitation. Fourteen adult inpatient units are surveyed, using seven teams of three members: (1) an APN (experienced P&I participant and team leader), (2) either an APN, CPP, or RN, and (3) a patient care associate.  Teams are assembled based upon nurses’ survey expertise, unbiased judgment, and patient population knowledge. 

Training:

Team leaders receive comprehensive instruction including eight hours of didactic education from a medical and nursing certified wound and ostomy specialist, as well as video pressure ulcer training.  A post test is used to assess understanding of pressure ulcer staging and promote survey interrater reliability.

Data Collection Process

The prevalence and incidence study is conducted quarterly for all adult medical, surgical, critical care and rehabilitation units.  Teams visit the same assigned units for consistency and building rapport with the nursing staff. The team members are responsible for evaluating, collecting, and recording pressure ulcer data. These data include the rate of hospital acquired pressure ulcers by unit and the percent of patients with nosocomial pressure ulcers. The Wound Coordinator acts as a resource and provides oversight when the wound stage is not determinable by the nurse.  Deficiencies in documentation are validated by a Manager who is proficient in the use of the computerized documentation system. Data collection forms are completed by an APN and all data are compiled by the NDNQI nurse coordinator. Pre- prevalence and post- incidence meetings are conducted to discuss issues and results of the studies.

This Midwestern Medical Center benchmarks against the following:

·        Hospitals within the organizational system using clinical excellence

·        Other hospitals within the NDNQI Database

·        KCL Corporation National database for Incidence Study

Implications for practice:

The Medical Center’s prevalence and incidence study clearly identifies occurrence of pressure ulcers, as well as the effectiveness and compliance with prevention and treatment interventions.  Results of the survey are used to compare outcomes against national benchmarks, assess quality of care, protocol development and product recommendation. Because of this initiative a decrease in nosocomial pressure ulcer from 30% to 7%.