Journey Update and Literature Review

• 6/4/2009
• Author: Nurse Scholar
• Category: Nurse Safety Scholar Blog on Pressure Ulcers
• 27703 Views
• 3 Comments
• 

I am just beginning my second month of this year-long project and am still trying to develop a good pace for working half-time as the WOCN for my hospital and working half-time on a project that I hope will find solutions to the barriers to success for pressure ulcer prevention programs. My hospital colleagues and new colleagues at Joint Commission Resources are amazingly supportive and I’m grateful for that much-needed support and guidance.

I am continuing with the review of the literature and have tried to focus primarily on finding articles that describe programs that show sustained improvements once all of the steps of the program have been initiated. I know that there are many such programs out there, and not everyone has published their results, so please send thoughts and comments to the blog. Every message is important.

I have much to learn about implementing a complicated program into complicated systems. First, there are 12 published guidelines geared specifically to prevention of pressure ulcers. All of these guidelines list similar interventions for prevention, e.g., repositioning, moisture control, nutrition and hydration, management of tissue loads, shear and friction. Most hospitals are using the NPUAP, NDNQI and WOCN recommendations to develop their programs.

Second, there are many articles that describe quality improvement projects that showed a successful short-term impact on the problem, but only a few that discuss improvement for a year or more. Few of these articles discuss participation from other disciplines. I am beginning to see a parallel to the challenges that are faced by my Infection Control colleagues. The Infection Control Nurse also must implement protocols that touch all hospital employees and must achieve very strong compliance with interventions (such as hand washing) in order to protect patients from injuries. I was joking (half-joking) with a colleague about wanting to hire some wound care nurses to do surveillance techniques in order to make sure that patients were being repositioned frequently and that soiled diapers were being changed quickly. Not a very realistic solution – just a thought. 

Based on my reading, it seems that one of the critical factors to success is the support of executive level leadership. This is the time to make proposals for the purchase of appropriate equipment and other resources to the CEO, COO, CFO, and CNO. The cost of caring for patients with pressure ulcers will have a serious impact on the bottom line, so the support for prevention is strong. Every hospital’s mission is to provide safe care to patients and prevent avoidable injuries, whether pressure ulcers, other skin-related injuries, infections or falls.

In my meeting with the Steering Committee, I was able to outline some of the specific barriers/challenges and potential solutions. We talked about better training for nurses for completing risk assessments, making sure that our nutritionist’s recommendations are ordered by the doctors, challenges with teaching doctors and nurses the NPUAP staging system for accurate documentation, availability and appropriate usage of pressure redistribution surfaces, the challenge of making sure that prevention strategies continue even when the patient is off the nursing unit, on stretchers waiting for tests, in the OR, ED or on other units receiving treatments.

Hospital nursing departments are vigilant about making sure that there is a program in place for preventing pressure ulcers, but other disciplines must also be actively involved in this process. Also, it is not enough to have the plan on paper. A dedicated leader needs to be provided with the time and resources to manage the program and maintain the momentum and positive outcomes. Our goal is to work with a hospital’s existing program, identify the gaps, barriers and challenges and develop a program that will lead to sustained reduction in incidence of pressure ulcers. I will continue to read everything I can find about this topic and invite you to pass on any recommended reading. I understand that there are many groups grappling with this issue and am hoping that we can share information and resources as much as feasible. Thank you to colleagues working on the PUCI project for generously sharing information and conversation. I have also had the opportunity to sit in on a meeting with the GNYHA and IPRO in New York to hear about their projects. 

Once site selection for our project is completed, I will write another update to keep all interested bloggers informed. “Keep the pressures low.”

Best regards,

Irene