Does It Matter “WHO” Does the Daily Skin Assessment?

Lori Pelham, RN. Lauren Wells, RN. Terri Kennedy, RN and TBICU Nursing staff“Trauma Burn Center, University of Michigan, Ann Arbor, MI

Purpose

Background

Methods

Results

Discussion

Conclusion

References

The TBICU has struggled to reduce and sustain our pressure ulcer incident rates below the standard for like units. The national mean is approximately 7%. However, national data suggests that certain patient populations are at higher risk. These patients include those with perfusion and hemodynamic instability, critical illness, poor nutritional status and those who are immobile or inactive.1 Many of those risk factors are present in TBICU patients. Because pressure ulcers are an ongoing issue for our trauma and burn patients, a six month program involving a 24hr Charge Nurse Skin Assessment Tool was implemented in the Trauma Burn Unit.

• A 6 month pilot project was implemented from July 2010 to January 2011 and a skin assessment was performed by the charge nurse and the patients bedside nurse every 24 hours• The program involved the development and utilization of a 24 hr charge nurse skin assessment tool that would track and trend new or existing pressure ulcers• The tool also guided the head to toe skin inspection over bony prominences and under medical devices thereby creating a systematic process for evaluating every patient•Charge nurses recorded any pressure ulcer findings on the tool, which kept a running catalogue of problem areas and the interventions initiated• Additionally, the Charge nurse validated that accurate documentation occurred in the electronic medical record and Risk Management report • Pressure Ulcer education was provided duringeach encounter•Resources were provided at every bedside forproper staging

• During the project there was lower than normal unit acquired pressure ulcer prevalence • While the tool was in effect the TBICU sustained a three month period with zero pressure ulcers in October, November, and December of 2010• Data demonstrated that unit acquired pressure ulcers tended to be in unusual places such as lips, hands and arms secondary to specific medical devices used for the trauma burn patient population • The percent of High Risk patients with a Skin Assessment documented in Centricity within a 24 hr period in TBICU was sustained at 100% during the project

• The evidence-based initiative demonstrated that the utilization of a Charge Nurse Skin Assessment Tool helped to:1. Identify pressure ulcers on admission2. Helped to track and trend prevalence and

incidence of pressure ulcers in the unit3. Empowered the nursing staff to prevent, identify

and treat pressures ulcers through education and partnering with a second set of eyes

4. Helps hard wire/standardize the practice of pressure ulcer identification

5. Fosters nurse to nurse collaboration

•The implementation of a Charge Nurse Skin Assessment Tool did resulted in a significant reduction in unit acquired Pressure ulcers•Staging and management of pressure ulcers improved•Staff became proactive rather than reactive in dealing with skin assessment•Identification and documentation of pressure ulcers present on admission improved•Risk Management Reporting increased•Improved staging and documentation helps to track and trend ongoing pressure ulcer prevalence in the TBICU

The purpose of this evidence-based initiative was to:• Identify pressure ulcers on admission • Reduce pressure ulcers during admission• To track and trend pressure ulcer prevalence in TBICU

1.Black, J M, et.al, Pressure Ulcers Avoidable or Unavoidable? Results of a National Pressure Ulcer Consensus Panel, February 2011.2.National Pressure Ulcer Advisory Panel, http://www.npuap.org/3.AHRQ Agency for Healthcare Research and Quality, http://www.ahrq.gov/consumer/bodysys/edbody6.htm

Room # Last name of Pt

Chg NurseInitial/Time

P/U FoundYes or No

If yes,then Stage and Location

Incident Report FiledYes or No

Centricity Documentation CompletedYes or No

Device relatedYes or No

11-1

11-2

15-1

Apr '10 n=10 May '10 n=13 Jun '10 n=15 Jul '10 n=13 Aug '10 n=10 Sep '10 n=14 Oc t '10 n=8 Nov ' 10 n=4 Dec '10 n=13 Jan '11 n=13 Feb '11 n=12 Mar '11 n=120%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

20.0%

15.4%

6.7% 7.7%

20.0%

7.1%

0.0% 0.0% 0.0%

46.2%

8.3%

0.0%

Pressure U lcer In ci den ce Rate - Unit Acq u ire d(In clu des P atien ts w ith P ressu re Ulcers Acq ui re d o n the Uni t)

TBICU

Initial N: 57 76 40 50Cont. N: 125 175 62 89

Initial N: 57 76 40 50Cont. N: 125 175 62 89

n = N um ber of Patient s EvaluatedInitial N: 57 76 40 50Cont. N: 125 175 62 89

Initial N: 57 76 40 50Cont. N: 125 175 62 89

n = N um ber of Patient s Evaluated