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Informational/Educational Report
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Reducing the risk of hospital-acquired pressure ulcers Kitty Doty, Jane Bridges, RN, MS, Kathleen North, Paula Hudon, Cheshire Medical Center/Dartmouth Hitchcock, Keene, NH Problem: .Feedback from physician to hospital administration raising a concern over number and severity of decubitis ulcers in debilitated patients discharged from the hospital in recent months. Investigation: Internal benchmarking data revealed this facility at 21st percentile of pressure ulcer frequency, as compared to other acute care facilities median of 13%. Purchase of beds with prevention and treatment surfaces over preceeding years introduced various models of beds coexisting on each nursing unit. This created confusion over correct useage. Skin/wound care policies and precedures, and daily flow sheet documentation in need of review/revision Action: .Wound Care committee named with assigned ownership of practice improvement. Available data reviewed and discussed to determine where we were and set goals. Audits of bed useage conducted on each nursing unit. Literature search conducted with information distributed to all members. Detailed educational needs identified of RN, LPN, and LNA staff. Physician educational program also scheduled Outcomes:.Different bed types labeled on footboards. Beds reallocated to nursing units based on at risk populations. Pressure Ulcer Knowledge questionnaire administered to LNA group prior to education. Average pre education score was 71%. Post education scores were 92%.100% attendance of group. Skin/Wound Care policies/procedures revised to reflect outcomes based nursing practice. Bed use audits revealed significant improvement in correct use of beds..Improvement to accurate wound care documentation: prior to initiative 83%, post edcation = 94%. Internal benchmarking at 6 months shows our facility at 10% pressure ulcer frequency Evaluation:.This was a successful improvement project in a 166 bed acute care hospital. Ongoing education will be necessary for new staff and when we make changes to our products. It is also imperative to have ongoing auditing of practice and feedback to involved staff. The National Quality Forum Safe Practices for Better Healthcare: A Consensus Report Effective Strategies to Reduce Pressure Ulcer Rates. Washington, DC: The Advisory Board Company, 2004 Agency for Healthcare Policy and Research, US Department of Health and Human services Treatment of Pressure Ulcers in Adults. 1994 National Pressure Ulcer Advisory Panel. Guide to Public Policy Interaction. 1995 Acute and Chronic Wounds: Nursing Management, 2nd ed. In: Bryant R (ed). Mosby Inc, 2000 Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses, Second Edition. In: Sussman C (ed). New York, NY: Aspen Publications, 2001. |
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