A Skin Care Algorithm Created by Nurses for Nurses

Purpose:
Hospital acquired pressure ulcers have been considered a preventable, negative outcome and an indicator of nursing quality. To decrease the incidence of acquired pressure ulcers, the Burke Rehabilitation Hospital wound team developed a skin algorithm in 2011 as a tool to improve nursing practice.

Significance:
Pressure ulcers are a major health concern. Despite meticulous care, pressure ulcers can develop from causes such as disease, immobility, incontinence, fragile skin, and poor nutrition. They affect patients of all ages, complicate care, potentially extend length of stay and affect reimbursement.

Strategy and Implementation:
The wound care team developed a skin algorithm for a quick reference for the nurse and to replace cumbersome reference books. Today, where immediate gratification is paramount, and time is money, quality resources need to be accessible. We developed the Burke Skin Algorithm (BSA) as a concise, visual tool explaining pressure ulcer stages, anatomical locations, prevention measures and treatment interventions. To implement this, we incorporated the KIS (Keep It Simple) phenomenon in our educational approach. The algorithm leads the nurse to make decisions based on their assessment, beginning with the question “Is the skin intact?” Based on the answer yes or no, the algorithm assists the nurse with interventions of prevention and treatment of the pressure ulcer or wound. Standardized physician orders were developed to support the algorithm. We streamlined skin care products that we found to be effective, well tolerated, and cost efficient to eliminate the dilemma of product choice.

Evaluation:
Benchmark data for 2011 and 2012 submitted for the rate of Burke patients with new or worsened stage II - IV pressure ulcers based on number of patients with present on admission pressure ulcers was 0.05 and 0.04 respectively. The rate for all other tier 3 facilities was 0.1 and 0.1 respectively.

Implications for Practice:
Our efforts at quality improvement provided timely access to a decision making reference, expedited ordering and application of appropriate preventive care measures, enhanced interdisciplinary collaboration, limited product waste and excess cost, and most importantly improved clinical outcomes.