Skin Care Clinical Nurse Champions: Protecting the Bottom Line

Purpose:
The purpose of this innovation was to engage clinical nurses to champion the implementation of evidence-based practice guidelines for pressure ulcer prevention to support the organization's goal of reducing the prevalence of hospital acquired pressure ulcers (HAPU) in an academic medical center.

Significance:
With reimbursements declining for HAPU, clinical nurses are in a pivotal role to positively impact both patient outcomes and organizational financial health. Significant reduction in HAPU can be achieved through evidence-based prevention and organizational investment in education and technology.

Strategy and Implementation:
This innovation used established clinical nurse EBP champions to focus on implementation of the newly developed SKIN CARE prevention bundle. The champions provided consultation through inservices, patient rounds, and documentation audits, and shared feedback on prevalence data. This quality improvement innovation consisted of education strategies such as, a required on-line self-learning module on prevention and staging for all clinical nurses, modification of documentation tools to improve daily skin assessment and to link pressure ulcer risk assessment to prevention interventions, and a “Less is Best” linen reduction campaign to maximize support surface effectiveness. In addition, technological investments included an easily accessible website with comprehensive EBP guidelines, installation of ceiling mounted lifts in every patient room for safe patient handling and frequent repositioning without friction and shear, and proactive use of low air loss surfaces for high risk patients.

Evaluation:
Through this innovation, the overall HAPU prevalence rates decreased by 58% from Q4 FY08 to Q4 FY09. When benchmarked with NDNQI Academic Medical Centers, the prevalence rates for medical, medical-surgical, critical care, and rehabilitation units met or outperformed the mean.

Implications for Practice:
This successful intervention highlights the influence of clinical nurses in improving patient outcomes through applying evidence-based practice guidelines, thus showcasing nursing's contribution to organizational fiscal health in an era of pay for performance.