Establishment of a Comprehensive Network-Wide Pressure Ulcer Assessment Process

Purpose:
A process improvement initiative regarding pressure ulcers focused on: improvement in the recognition and documentation for ulcers present on admission; early, appropriate and efficient interventions; early identification of risk factors; and, positive impact on net margin.

Significance:
Pressure ulcers are a vexing and topical issue. Significant resources are required to treat patients with advanced pressure ulcers. The Centers for Medicare and Medicaid Services no longer reimburses costs incurred for hospital-acquired pressure ulcers that could have been reasonably prevented.

Strategy and Implementation:
A multidisciplinary team developed an algorithm to support the identification of pressure ulcers for units participating in the process. This approach standardized work resulting in consistent: skin assessment; notification of physicians; reporting of findings in the patient safety reporting system; and, communication to receiving units. Scantron tools were developed and completed for six months by the Patient Care Services unit-based, shared governance process improvement council members; these council members made possible immediate “loop closure” for either positive feedback or needed re-education with the nursing staff.

Evaluation:
In 10 out of 12 months, there was 100% effectiveness identifying Stage III/IV pressure ulcers on admission and preventing hospital-acquired Stage III/IV pressure ulcers. In each of the non-compliant months, only one present-on-admission pressure ulcer was coded as “insufficient documentation.”

Implications for Practice:
This nurse-driven process was successful because it was conceived and designed by an interprofessional team, and was the right thing to do. Data suggests that identification of pressure ulcers on admission and prevention of early pressure ulcer deterioration to Stage III/IV are clinically feasible.