1.      Describe the process used by St. Joseph’s Regional Medical Center in Patterson, N.J. to develop internal experts in pressure ulcer prevention and treatment.

2.      Describe how the standardized evidence-based treatment plans for various stages of pressure ulcers and the standardized pressure ulcer documentation tool were developed and implemented 
PURPOSE: The purpose of this session is to share the process used to develop evidence-based treatment plans for the prevention and treatment of pressure ulcers
 

This session will describe one institution’s process to develop internal experts, develop evidence-based practices for prevention and treatment of pressure ulcers and implement these practices to lower the pressure ulcer rate in the institution. 
SUMMARY OF PRESENTATION

As a result of analyzing NDNQI data on pressure ulcers, the Nursing Department at St. Joseph’s regional Medical Center recognized that there were significant variations in the treatment of pressure ulcers and that the documentation of pressure ulcers was inconsistent.  A department-wide project was designed to develop internal staff as experts in pressure ulcer management, to develop evidence-based standards of care for the prevention and management of pressure ulcers, and to provide easy to use documentation tools. 

A newly graduated APN was chosen to complete a 10 graduate credit online program to prepare her for National Wound, Ostomy, and Continence (WOCN) Society certification.  Her enrollment provided the hospital with both ongoing, current knowledge in the field and an enthusiastic novice to implement the designed plan.  The hospital also benefited from timely membership in a NJ Statewide Pressure Ulcer Collaborative that provided the APN with access to colleagues with the same concerns and goals and a monthly forum during which to discuss these concerns.  The hospital pressure ulcer committee was reorganized under the direction of the APN.  The committee, consisting of staff from all of the adult units, was charged with developing evidenced-based standardized treatment plans for the various stages of pressure ulcers as well as a standardized documentation tool. 

As a result of this program, the pressure ulcer rate decreased from 2.72 in April 2006 to 1.11 in June 2006, saving the institution approximately $500 to $40,000 per pressure ulcer (Lyder, C.,JAMA, 2003) and immeasurably improving the quality of care for the patients.  A long-term goal of the project is to quantify the decrease in LOS and, therefore, the financial impact of this program. 

IMPLICATIONS FOR PRACTICE:

A successful pressure ulcer prevention and treatment program required the development of specialized staff as well as an evidenced-based treatment program.  A plan that included staff training as well as standardized treatment plans and documentation has been successful in dramatically decreasing the incidence and prevalence of pressure ulcers in the institution and improving the documentation.  It is well documented that the cost savings associated with pressure ulcers is stage dependent and ranges from $500 to $40,000 per pressure ulcer.  More importantly, the quality of care offered the patients is immeasurable.