Pressure Ulcer Prevention: Resource Nurse Model to Foster Staff Leadership and Improve Patient Outcomes

Purpose:
In 2004, pressure ulcer prevention was an overwhelming challenge in our 500 bed plus hospital. Creative strategies to engage the staff were needed. Linking existing programs of nursing quality, nursing education, and professional practice, the OWL program (Ostomy Wound Liaison [nurses])was born.

Significance:
Prevention of pressure ulcers is a national concern. In our facility, pressure ulcer rates needed to be decreased to at or below the NDNQI means for ICU and medical-surgical units.

Strategy and Implementation:
OWLs are unit based staff nurses trained in skin care and prevention of pressure ulcers. They serve as clinical experts and leaders. OWL education focuses on evidence-based practice to achieve consistent outcomes and how to determine if research supports what they are doing to prevent and treat skin breakdown. OWLs learn what NDNQI benchmarking data means and how to utilize it to motivate their peers. They are accountable for their unit's pressure ulcer prevalence results. They participate in unit weekly screening of patients which includes staff education. They conduct monthly pressure ulcer prevalence studies to formally measure progress. The Pressure Ulcer Prevention team, initially chaired by nursing leadership, is now multidisciplinary and chaired by staff nurses. Reviewing quarterly data from NDNQI, they compare it to hospital data and set goals for their units and the hospital. OWLs review the evidence and make adjustments to protocols, procedures and products used.

Evaluation:
Outcomes are impressive with pressure ulcer prevalence rates in adult ICU FAPU decreasing from 11.96% in 2006 to 7.65% through June in 2009. Adult medical –surgical units reflected similar drops from 3.24% to 1.0%. The OWL program has grown to include all units with over 70 OWLs.

Implications for Practice:
Bedside critical care nurses conducted nursing research to determine which factors in addition to Braden scores were most strongly associated with pressure ulcers in their population. The model of staff nurse experts (resource nurses)was expanded to other quality initiatives in the hospital.