Perioperative Wristband Alert Program

Purpose:
To describe the process and evaluation of an innovative strategy to address hospital acquired pressure ulcers (HAPUs) developed by the Periop Skin Care Committee at an academic medical center. The goal was to improve care of surgical patients from the periop setting to post-surgical care units.

Significance:
HAPUs, a National Quality Forum adverse event, were addressed by the Periop Department after CMS announced reimbursement changes to patients . HAPUs may develop 72 hours post op, an excessive time after discharge from the O.R. Education about the origin of a pressure ulcer is significant.

Strategy and Implementation:
Initially the committee identified the need for continuing education regarding skin assessment, and documentation. In response to this a monthly newsletter; a Quick-Actions Guide, in-service education programs, and perioperative skin assessment/hand-off tools were developed. In March 2009, a quantitative study was conducted. 1,235 charts were reviewed for intra-operative skin outcomes. Data collection revealed 16 patients with skin changes ranging from blanchable redness to blistering. Two patients were identified with pressure ulcers. A Post-Operative Wristband Alert Pilot Study was conducted from September 24 to December 18, 2009. At the conclusion of the pilot 309 wristbands were applied. Of the 309 patients 16 were noted to have skin assessment changes at the time of discharge from the OR. In May 2010 the Committee offered a Skin Care Fair for the Surgical Patient to nurses hospital wide. In June 2010 the committee published the Perioperative Services Wristband Alert Program.

Evaluation:
Surveys of the nursing units revealed improved communication between periop and post-op nursing departments which resulted in improved patient outcomes. Also Chart Audits were completed.Findings:12 documented skin changes ranging from blanchable redness to suspected deep tissue injury/unstageable.

Implications for Practice:
The Wristband Alert Program ensures there is a mechanism in place to promote coordination of care of the patient from the perioperative to the post-operative care units. The program assists with identifying pressure points most at risk for development of HAPUs related to surgical positioning.