Innovation of Skin Risk Assessment to Support Quality Improvement

Purpose:
1. Describe Skin Integrity Risk Assessment (SIRA) developed to accurately identify pressure ulcer (PU) risk in all ages. 2. Demonstrate use of SIRA within electronic health record (EHR) as innovative method for PU prevention. 3. Include device-related pressure ulcer prevention.

Significance:
1.No risk assessment scale (RAS) validated across lifespan necessitates use of multiple tools in hospitals with varied populations. 2.Current tools are paper-based. Use of EHR improves process. 3.Devices are a leading cause of PU in hospitalized patients, current RASs do not include this risk.

Strategy and Implementation:
The goals were to create a tool which is easy to use and understand, suitable for all ages, and when implemented in an EHR provides nursing decision support for PU prevention interventions. SIRA includes 8 subscales rated independently so there is no need for 'scoring' to identify a threshold for risk. The EHR prompts the nurse to complete SIRA on admission and every shift. Patient assessment findings are either 'at risk' or 'not at risk' based on definitions provided in the tool. The nursing decision support recommends appropriate interventions for identified risks when the RN selects an ‘at risk' assessment by opening a separate documentation screen with a list of evidence based prevention interventions. The interventions planned by the nurse are then visible in the EHR nursing assessment screen. Nursing staff were educated during their quarterly staff meetings. SIRA documentation specifics were reviewed peer to peer. SIRA was implemented hospital-wide on October 4, 2011.

Evaluation:
SIRA is a comprehensive PU risk assessment that includes devices, promotes implementation of interventions for identified risks with an intuitive workflow. Staff report liking SIRA and rates of RA completion have improved. IRB submission is in process for reliability and validity data.

Implications for Practice:
An RAS that is facile, compatible with EHR work process, and a single tool across the lifespan will drastically change PU prevention practices. Our expectation is SIRA will increase awareness of PU risks, cause nurses to become better advocates for PU prevention, thus decrease the occurrence of PUs.