Keeping Our Eyes Peeled For Pressure Ulcers: The 4-Eyed Assessment RN and PCA together at the bedside

Purpose:
Acquire early identification of impaired skin integrity that will lead to timely nursing interventions, improved patient outcomes, and a decreased incidence of hospital acquired pressure ulcers. Additionally working together fosters teamwork and enhances learning.

Significance:
Pressure ulcers cause harm, pain and hinder patients recovery. They contribute to the development of serious infections and add to hospital length of stay. Pressure ulcers not identified within 24 hours of admission are hospital acquired and reimbursement for their care and treatment is in jeopardy

Strategy and Implementation:
All new admissions to the unit have their skin assessment completed using the 4 Eyed method which pairs an RN/PCA/ or other team member (resident or attending physician) together at the bedside, to assess the patient for altered skin integrity, or risk for altered skin integrity which could lead to a hospital acquired pressure ulcer. In addition to routine documentation, each team completes a brief survey to aid in the collection of data about this team method. The RN documents the findings of her evaluation on the Admission Assessment in the Electronic Medical Record (EMR). Pressure ulcer prevention and treatment order sets are individualized and included in the nursing plan of care.

Evaluation:
Sixty six surveys were completed over a 12 week period. The surveys indicated that a) of the admissions reviewed 83% were new admits to the unit, b) 100% of the surveys were completed by the RN and PCA or other Healthcare provider together and c) 53% of the patients had impaired skin.

Implications for Practice:
Working together to identify alterations in skin integrity increases teamwork, along with teaching and learning among team members.This approach also demonstrates to the patient and family the teamwork in action and encourages real-time communication of findings and of the proposed plan of care.