More than Skin Deep: Pressure Ulcer Prevention in Endoscopy

Kari Isaak-Weigman, APRN, CNS; Samantha Stevens, BS, RN; Lindsy Randall, MSN, MHA, RN; Val Murphy, ADN, RN, Craig Gillett, MS, RN, NESDepartment of Nursing; Division of Gastroenterology and Hepatology

Mayo Clinic, Rochester, Minnesota

© 2016 Mayo Foundation for Medical Education and Research

Figure 2: Pressure Ulcer Prevention Strategies

Focused skin assessment

Scheduled repositioning

every 120 minutes

Use of skin integrity products

Skin Integrity Prevention Plan

Skin cleanser & protectant cream

Gel overlay mattress

Dressings

Absorbent pads

Skin Integrity Products

Review patient’s electric medical

record

Screen patient by asking

“Do you have any sores or

open wounds?

Skin Integrity Screening

High-risk factors

Known skin alterations

Repositioning

Skin Integrity Documentation

BackgroundPressure ulcer development is an adverse event which is serious, and largely preventable. The National Pressure Ulcer Advisory Panel (NPUAP) 2014 Clinical Practice Guidelines, recommend a risk assessment be completed to identify patients at risk for developing a pressure ulcer. The NPUAP Prevention of Pressure Ulcers recommends the following interventions for patients identified at risk:

• Conduct a skin assessment

• Document any skin alterations

• Implement a pressure ulcer prevention plan (e.g. moisture management, repositioning every 120 minutes)

Data comparing 2013 and 2015 has shown within Mayo Clinic Rochester endoscopy suites:

• Increased patient acuity

• Increased complexity of procedures

• Increased advanced endoscopy peri-procedural times. (Figure 1)

• Pre/peri/post procedural times averaged 148 minutes

Aims In light of the trending data, an endoscopy staff workgroup was formulated to:

• Investigate methods to increase endoscopy staff ‘s baseline knowledge of pressure ulcers and preventative strategies.

• Develop and integrate preventive strategies into the endoscopy workflow

ProcessThe workgroup created a survey to assess the baseline knowledge of pressure ulcers and prevention methods of the endoscopy staff. An educational program was developed based upon the survey results. The educational program included a PowerPoint presentation with a video component. The video’s primary focus was to demonstrate the patient and staff interactions which focused on multidisciplinary pressure ulcer prevention and incorporating preventative strategies in the workflow. (Figure 2)

Endoscopy Pressure Ulcer Knowledge Survey Results

47%

18%14%

24%

0

20

40

60

80

100

Correctly identify a pressure ulcer can develop in 120 minutes

Correctly identify areas prominent

to develop pressure ulcers in

procedural positions

Correctly identify factors which will increase risk of pressure ulcer

development in a procedural environment

Correctly identify which comorbidities will increase risk of

pressure ulcer development

Pre-education programPost-education program

Incr

ease

(%

)

Outcomes• Educated endoscopy staff as the initial survey results revealed education was

needed for pressure ulcer prevention in endoscopy suites.

• Selected pressure ulcer prevention products based upon which products best suited the patient population in the endoscopy suites.

• Developed templates to streamline and standardize documentation of pressure ulcer prevention strategies.

• Developed an effective screening question based on nursing staff’s feedback, literature review, and benchmarking.

• Confirmed intergration of the pressure ulcer screening question into the pre-procedural process did not cause any additional nursing staff burden.

• Promoted endoscopy staff to take the time to think differently and be aware of how their care impacts patient skin events.

ReferencesNational Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2014). Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. E. Haesler (Ed.). Perth, Australia: Cambridge Media

AcknowledgmentsWe thank the endoscopy staff who participated in the workgroup:

Nav Buttar, M.D., Lindsey Elder R.N., Michelle Holtan R.N., John Martin, M.D., Jim Prechel, Sarah Robinson L.P.N., Melissa Sederquest, Julie Stene, R.N, Lori Van Tassel R.N., Bill Tice, & Susan Wittren, R.N.

Practice Implications• Pressure ulcer prevention strategies improve the quality of care, reduce

healthcare costs, and further empower endoscopy staff to be vigilant guardians of patients.

Figure 1: Advanced Endoscopy Peri-Procedural Time

3228

32

48 4553

0

20

40

60

80

100

June August December

Ave

rage

min

utes

20132015

*Advanced endoscopy is a subspecialty of gastroenterology procedures dedicated to the diagnosis and treatment of digestive diseases which utilize endoscopy in combination with other diagnostic and surgical techniques to effectively address numerous conditions.

Procedure Volumes: June 2013 (16); June 2015 (17); August 2013 (22); August 2015 (23); December 2013 (11); December 2015 (23)