Pressure Ulcer Role Awareness: Bridging the Knowledge and Practice Gap

Purpose:
To coordinate nursing-driven Pressure ulcer (PrU) assessment, interventions and documentation through a standardized education class. By enhancing nursings' role and awareness of PrU prevention, nosocomial, full thickness pressure ulcer cases and NDNQI PrU prevalence < 4% rates will decrease.

Significance:
Pressure ulcer awareness and prevention have gained momentum and importance for bedside clinicians, payors and patients. Nosocomial PrUs are considered a nursing-sensitive, preventable clinical outcome. Prevention interventions used to maintain skin integrity are started and managed by the RN.

Strategy and Implementation:
Many nurse-driven, skin safety interventions had been developed; effort was needed to unify these activities. A 30 minute CWOCN-led class was created to bridge the PrU prevention knowledge and practice gap for all nursing staff; it included review of: (1) the hospital policy on admission & shift physical skin & PrU risk assessment; (2) electronic medical record, emr, documentation; (3) PrU assessment & staging of bony & device-related injury (along with the NDNQI PrU Staging Modules One & Two); (4) conceptual and applied use of the Braden scale tool; (5) the PrU prevention bundle set; (6) the emr hyperlinked references & resources, i.e. Braden subscale definitions & the standardized bed decision guide; (7) nursing report & communication; and, (8) consulting the CWOCN, a SKIN team member or a unit-based, Wound Care Champion. Competency validation was achieved with practice case scenarios to assess pressure ulcer staging, Braden score accuracy, PrU prevention and documentation.

Evaluation:
The CWOCN monitored all nosocomial, full thickness PrUs; NDNQI PrU prevalence was also assessed. Six months into the education program, one full thickness PrU case was identified (present on admission but not documented.) Quarterly PrU prevalence decreased to 3.6% - all partial thickness lesions.

Implications for Practice:
This education was a successful adjunct in improving facility-wide pressure ulcer prevention. It included review of the nursing-specific assessments, documentation, risk tools, and interventions available to the nurse – all geared to enhancing role awareness in relation to clinical outcomes.