Weekly Interdisciplinary Skin Rounds in a Community Hospital: Preventing Pressure Ulcers, Improving Care

Purpose:
Interdisciplinary Skin Rounds serves to support our organization's healthcare providers to prevent and manage pressure ulcers at the point of care, in an acute care setting. We aim to have fewer pressure injuries and increased patient and family satisfaction with their care.

Significance:
Patients that sustain pressure ulcers experience increased pain, rehabilitation time, risk for sepsis and death, and costs. We identified our healthcare providers lacked knowledge of skin assessments and pressure ulcer prevention and management strategies; pressure ulcer rates were high.

Strategy and Implementation:
Our hospital's Pressure Ulcer Prevention Team is an interdisciplinary group of healthcare providers that worked with the Clinical Nurse Leaders throughout the organization to create a process called Skin Rounds. Skin Rounds occurs weekly at the same day and time, and proceeds throughout the hospital; patients that meet pre-defined criteria are offered Skin Rounds. During rounds, the Wound Center physician and/or nurse practitioner assists caregivers to assess the patient's skin, clarify the skin condition, stage a pressure ulcer if necessary, assess current interventions, offer recommendations for additional care, and provide education for all staff and the patient and family. Input from disciplines such as nutrition, pharmacy and the rehabilitation services is standard; patient and family involvement is invaluable. Skin Rounds is not a billable consultation, and collaboration between the Wound Center provider and the attending physician is an important communication.

Evaluation:
Skin Rounds success is measured by chart audits, NDNQI prevalence studies, self-assessment by healthcare providers, and patient and family interviews. Other measures include types of education provided, number of patients evaluated, and type and number of interdisciplinary providers impacted.

Implications for Practice:
Weekly Skin Rounds reduces pressure ulcers through education and real-time decisional support for bedside clinicians from expert providers in skin care. The process promotes interdisciplinary collaboration, and involves patients and families in care decisions.