The Pressure Is On: Skin Savers to the Rescue

Purpose:
High unit-acquired pressure ulcer rates and a sentinel event necessitated a practice change for an inpatient medical unit. A peer education plan and a skin care competency were implemented to improve skin assessment accuracy and documentation and to reduce the incidence of pressure ulcers.

Significance:
Pressure ulcers adversely compound health care costs, length of stay, and patient satisfaction. Peer education empowers staff and leads to the compliance and integration of evidence-based prevention strategies into practice to deliver quality nursing care and improve patient care outcomes.

Strategy and Implementation:
A peer education plan was developed by a unit level evidence-based practice team, called the Skin Savers, to address the identified knowledge deficit of skin and wounds. Utilizing a train-the-trainer method, the Skin Savers received essential education from Wound, Ostomy, and Continence Nurses in order to effectively educate their peers. The Skin Savers subsequently provided mandatory classes for the staff addressing wound assessment, pressure ulcer staging, prevention interventions, and the obligatory documentation. Completion of the National Database of Nurse Quality Pressure Ulcer Training modules was also required. Skin care protocols were utilized for the treatment of early staged pressure ulcers and minor wounds. Body maps facilitated nursing assistant to nurse communication of skin problems. Mirrors were introduced to improve skin assessments. Skin care competencies were created to validate and document the post-education knowledge of the nurses and nursing assistants.

Evaluation:
The program was a success as demonstrated by improvements in wound documentation from 61% to 85%, skin assessments performed upon admission and transfer from 81% to 90%, and prevention intervention documentation from 20% to 61%. Ultimately, the pressure ulcer prevalence rate fell from 6.7% to 0%.

Implications for Practice:
This evidence-based peer education program, inclusive of a skin care competency, proved to be effective in the prevention of pressure ulcers and can be generalized to other nursing settings in order to improve skin and wound knowledge and to prevent the incidence of pressure ulcers.