Mobility Matters! Preventing Hospital Acquired Pressure Ulcers Utilizing Best Evidence

Purpose:
To describe the development of an evidence-based nurse driven protocol that guides clinical associate's competency and improves patient outcomes through accurate assessment and formation of a plan of care to prevent and manage pressure ulcers.

Significance:
The nursing protocol was developed using best evidence and involved participation of nurse associates & CWOCN Clinical Specialist for pilot and refinement of operationalizing the protocol. To implement protocol use in daily practice, the skills acquisition program, Mobility Matters! was created.

Strategy and Implementation:
The protocol was reviewed and refined based on feedback from Practice Council, wound resource nurses, and pilot test nursing units. “Mobility Matters!” was an interactive bundled skills acquisition program that addressed three nursing sensitive indicators - prevention of pressure ulcers, falls, and reducing risk of immobility. Braden Score Risk Assessment & the Nursing Process session case studies addressed the needs of each patient followed by group discussion. Each subcategory of Braden was reviewed and a plan of care developed that included problem identification, goal, and nursing interventions. Interventions where based on the nurse-driven evidence-based Prevention & Treatment Protocol. This protocol guides the nurse with the tools to provide safe effective care for their patients. Competency was assessed at the bedside using a train-the-trainer format along with a defined process for on-going monitoring.

Evaluation:
Measures of effectiveness included: post-test knowledge evaluation, competency evaluation with Interdisciplinary Rounding, end-of-trial evaluation with clinical associates, hospital monitoring of hospital acquired pressure ulcer (HAPU), and End of Shift Checklists.

Implications for Practice:
A best evidence protocol was incorporated into a skills acquisition program followed by competency validation and on-going monitoring. The goal of this strategy was to prevent/manage pressure ulcers, prevent falls, and effects of immobility to keep patients safe and improve outcomes.