From Pressure Ulcer Prevalence to Incidence with Implementation of Resource Nurses and an Electronic Medical Record

Purpose:
Decentralizing pressure ulcer (PU) data collection in a 555 bed tertiary care hospital was done by nursing resource teams (NRT) trained and supervised by Wound Ostomy Continence (WOC) Nurses. A new electronic medical record (EMR) and NRTs enabled a shift from prevalence to incidence PU monitoring.

Significance:
PU prevalence is only a snapshot measure of pressure ulcer events but incidence is a measure of all occurrences. A reliable measure of nosocomial PU incidence was needed to evaluate nursing practice and improve patient outcomes as national healthcare groups call for more incidence data reporting.

Strategy and Implementation:
In March 2005 a group of 13 NRTs representing the hospital's nursing units were recruited for the purpose of completing quarterly PU prevalence surveys. The teams became members of the Skin Management Committee facilitated by the WOC Clinical Nurse Specialist and met monthly for wound education, evaluation of prevalence data, and reporting unit based activities to impact PU nursing practice. Through committee activities staff were empowered and mentored to evaluate PU prevalence at the unit level and make individualized action plans for better patient outcomes. This reduced PU events. Starting with the June 2008 prevalence survey a new EMR improved efficiency of data collection and provided more accurate patient information. Screens for skin assessment charting in the EMR provided more precise documentation of wound etiology resulting in more accurate PU prevalence reporting. With the EMR we were able to make the switch from quarterly prevalence to monthly PU incidence reporting.

Evaluation:
Over the years that the NRTs have been in place we have seen a steady decline in PU prevalence. With EMR, our hospital wide incidence rate for June 2009 was only 0.22%, far below the national goal of being less than 2%. The EMR provided accurate data and a venue for measuring PU incidence.

Implications for Practice:
Our PU rates may be lower than national averages partly due to accurate wound documentation. Empowering a core group of NRTs with the oversight efforts of the WOCs and adopting an EMR enabled us to demonstrate remarkable PU outcomes within a shared governance model.