ABC'Skin

Purpose:
The ABC'Skin Project demonstrated how a multidisciplinary team, using NDNQI benchmarks, created a culture change within the hospital. A sustained reduction in hospital acquired pressure ulcers was achieved using a variety of strategies, teamwork and careful monitoring.

Significance:
The NDNQI quarterly pressure ulcer survey data provided a catalyst for organizational climate change regarding the value of skin care. When our hospital's pressure ulcer prevalence was significantly above the national mean, the staff and leadership were motivated to change practice.

Strategy and Implementation:
The ABC'Skin care bundle translates skin risk assessment into nursing interventions designed to prevent pressure ulcers. The ABC' Skin project increased hospital wide awareness of pressure ulcer prevention by aligning skin with Airway, Breathing and Circulation. Support staff, providers, leadership and other disciplines were identified as team members in reducing pressure ulcer risk. The addition of a skin care bundle provided an immediate documentation opportunity for an individualized plan of care based on a validated pressure ulcer risk assessment. The electronic record was redesigned to a “one stop” pressure ulcer prevention bundle directly associated with the risk assessment.

Evaluation:
After implementation of the pressure ulcer bundle, NDNQI hospital acquired pressure ulcer rates were reduced by more than 6% over six consecutive quarters. Unit acquired rates, including critical care rates, reached zero. The interdisciplinary staff have been encouraged and energized by the change.

Implications for Practice:
NDNQI benchmarks stimulated a culture change which was supported by interdisciplinary leadership. Hardwiring evidence based pressure ulcer prevention strategies with a validated risk assessment contributed to reduction in hospital acquired pressure ulcer prevalence as measured by quarterly surveys.