Lessons Learned

• 3/4/2010
• Author: Nurse Scholar
• Category: Nurse Safety Scholar Blog on Pressure Ulcers
• 14696 Views
• 3 Comments
• 

My final month as the JCR/Hill-Rom Nurse Scholar is here and I leave this project with a greater appreciation for the hard work that nurses and nursing assistants do every day as they provide the best possible care for their patients. Every day, nurses all over the world are faced with more and more responsibilities. Nurses work hard to protect patients from misinformation, infections, wrong medications, wrong tests, falls, pressure ulcers and more. At the same time they constantly assess patients' responses to all sorts of illnesses, medications and treatments. 

For the past year I have had the privilege of working with amazing nurses who have focused on making sure that patients are protected from pressure ulcers. Four different hospital systems have participated in this project, which began with the idea that there may be some barriers and gaps to implementation of existing pressure ulcer programs. 

Here are just a few of the lessons learned:

Pressure Ulcer Prevention (PUP) Programs

The information gained from risk assessments is not used to develop the prevention plan. Risk scores are not routinely passed on in hand-offs. Doctors never heard of Braden. Why? Shouldn't they know if their patients are at risk for pressure ulcers?

Tracking patients that are at risk for pressure ulcers revealed that patients, as they move throughout the hospital for testing, dialysis, and procedures, may spend a significant amount of time on stretchers in the care of transport staff and other ancillary technicians. However, most PUPs only educate nursing staff about prevention interventions. High-risk patients may be positioned on thin stretcher mattresses in one position for periods of four hours and more. Should pressure ulcer prevention information be provided to other departments besides nursing?

A sample action plan taken from the various sites shows the progression from identification of the gap/barrier to implementation of the solution. 

Gap: Limited education for Patient Care Associates (PCA) related to the PUP program. (Although PCAs routinely provide bedside patient care, they were not included as members of the Pressure Ulcer Prevention Committee.)

Problem was identified after a survey of PCAs revealed their interest in learning more about the hospital's PUP program.

Next steps: Create learning objectives, select the education method, determine frequency of education, confirm which PCAs will be taught, deliver the education, measure the effectiveness using a post-education test.

Gap: Pressure ulcer prevention for patients with extended stays in the ED. One hospital noted that there is a backlog of patients in the ED awaiting transfer to med/surg units. The high-risk patients were on standard stretcher mattresses and repositioning was challenging due to the narrow widths of the stretchers. 

Next steps: Due to the number of high-risk patients, arrangements were made to purchase new stretchers with pressure redistribution mattresses. In addition, education was provided for the ED staff related to identification of high-risk patients and interventions that would promote pressure ulcer prevention.

Other gaps in prevention include delays in nutritional support for extended periods of time when patients are NPO waiting for tests to be completed; using the nutrition score on the Braden tool as a trigger for nutrition consults, which leads to unnecessary nutrition consults due to incorrect scoring and assumptions that nurses are aware of all resources for prevention; confusion about how to use skin care products, lift equipment, special beds and more.

A survey of turning practices revealed that nurses’ perceptions of actual turning times may not reflect the actual turning.

There is much more work to be done! Good news! This project has been extended for an additional six months. JCR and Hill-Rom will be introducing the new JCR/Hill-Rom Nurse Scholar on April 1, 2010.  I will be able to stay connected to this project since my own facility, Beth Israel Medical Center in New York, New York, is one of the participating hospitals. I look forward to the next six months and the opportunity to pass on what we are learning to the nursing community.

Keep them turning,

Irene