Tips for Improving a Pressure Ulcer Program

WOUND CARING
A newsletter for the wound management clinician
Volume 3 Issue 2
Permission Granted
Medical Inc.

Use these clinically proven strategies for preventing
and treating pressure ulcers

IF YOU WANT TO LEARN how to do something better,
talk to the experts.

That's essentially what staff members from over 42 hospitals in the southeastern United States did last year as part of a collaborative benchmarking study on pressure ulcers.

Staffers from each hospital compared their performance of certain activities related to pressure ulcer prevention and treatment- called the critical success factors- with those of the other participants. The nine critical success factors included how comprehensive the pressure ulcer protocol was, how easy it was to use, how information about pressure ulcers was tracked and used, and how applicable the protocol was to long-term and home care.

Benchmark hospitals-hospitals where prevention and treatment activities were performed best according to the study criteria-were identifled for each critical success factor. Their methods are the basis for the 54 best practices noted. Here are the top 10.

  1. Encourage various disciplines to help develop your hospital's pressure ulcer protocol. This not only creates a comprehensive program, but it also allows each discipline to clearly see its role in pressure ulcer care. All benchmark hospitals had a skin/wound care team that included representatives from social services, pharmacy, nutrition/dietary, materials management, physical and occupational therapy, medical staff, nursing, and an enterostomal nurse or wound-care specialist. These teams created and revised the hospital's pressure ulcer protocols and teaching materials.
  2. Incorporate clinicalpractice guidelines from the Agency for Health Care Policy and Research (AHCPR) into your hospitals pressure ulcer protocol. Two AHCPR clinical practice guidelines deal with pressure ulcers: Treatment of Pressure Ulcers and Pressure Ulcers in Adults: Prediction and Prevention. (For more information, call the AHCPR Publications Clearinghouse toll-free number: 1-800-358-9295.)
  3. Use a valid and reliable risk-assessment tool to assess your patients' skin. The Braden and Norton scales were cited by benchmark hospitals.
  4. Develop a clinical pathway for pressure ulcer prevention and treatment. This helps simplify pressure ulcer management from the physician's office through hospitalization and into home care. A clinical pathway also ensures that all caregivers follow the same protocols.
  5. Develop quick reference sheets on pressure ulcer protocols and keep them handy.One benchmark hospital produced laminated sheets showing the pressure ulcer staging system (including pictures of pressure ulcers in stages I through IV) and the decision-tree for specialty-bed usage. These sheets- which are posted at every bed- also include a grid of wound descriptions and treatment options.
  6. Monitor specialty-bed usage.One benchmark hospital evaluates specialty-bed usage weekly. If usage exceeds a certain level, the wound-care specialist begins monitoring patients in those beds. If usage is inappropriate, the wound-care specialist informs the nurse-manager, who then contacts the physician. At another benchmark hospital, the specialty-bed vendor provides weekly reports showing when and why a bed was initiated and the length of stay of the patient using it
  7. Designate a nurse on each unit as a skin-resource person. This nurse can help maintain the skin-care program and serve as a liaison between the wound-care specialist and the unit's staff.
  8. Perform routine pressure ulcer prevalence studies. These studies help determine the hospital's prevalence rate, the hospital-acquired prevalence rate, and the number of at-risk patients. All benchmark hospitals performed these studies at least yearly.
  9. Keep your community informed aboutyour hospital's reputation for pressure ulcer care. One benchmark hospital initially provides free wound-care services for home health care agencies, later contracting with the agencies to provide these services for a fee. Another hospital mails letters to long-term care facilities, home heath care agencies, and families detailing its wound-care services.
  10. Help indigent patients get proper care and supplies. Seek help from churches, community social ministries, and the Salvation Army. Contact local politicians to obtain financial assistance for patients. This benchmark study was sponsored by The SunHealth Alliance, Hill-Rom, and Johnson & Johnson Medical, Inc. You can read more about it in the March/April 1996 issue of Advances in Wound Care.