Vol. 8 Issue 16
Preventing Skin Breakdown
Charlton Memorial Hospital's Skin Care Committee achieves great results through dedicated ulcer prevention strategies
Staff members at Charlton Memorial Hospital, the Fall River, MA, campus of Southcoast Hospitals Group, celebrated a day of recognition July 8 for members of the Charlton Skin Care Committee. They acknowledged the achievements of the members, who have been a cohesive group since the committee's inception in 1996, and joined the entire nursing staff to celebrate the important work they do to prevent skin breakdown in Charlton Memorial's patient population.
The Skin Care Committee has worked closely with staff and nursing personnel to address multiple skin issues, including pressure ulcers, and has elevated the staff's awareness of these issues.
A Nurse-Sensitive Indicator
Education and diligence by the Skin Care Committee and nursing staff have made a marked difference in this nurse-sensitive indicator. Charlton Memorial's pressure- ulcer prevalence rates have decreased and prevention strategies are becoming second nature.
"I have learned a great deal by being a part of this committee and really enjoy sharing this insight with my co-workers," said Martha Dufresne, RN, who has been part of the committee for the past 12 years. "Guiding staff with my knowledge of wound care, prevention strategies and documentation issues has become an integral part of my role as a Skin Care Committee member."
The success of the Skin Care Committee is due to the multidisciplinary group who serves as a resource to staff on their units and provides coverage for the wound, ostomy, continence (WOC) nurse, if necessary.
Standards & Education
The first major undertaking of the Skin Care Committee was to develop standards of care/practice for the prevention and treatment of pressure ulcers. The Agency for Healthcare Research and Quality Clinical Practice Guidelines numbers 3 and 15 were used to develop these standards of care. The Braden Scale to access pressure-ulcer risk was introduced at the same time.
The Skin Care Committee then completed the first pressure-ulcer prevalence study to define baseline results before implementing the new standards. Nosocomial pressure-ulcer rates at that time were 12-16 percent. The committee quickly realized documentation on admission was the cause, resulting in elevated rates of nosocomial pressure ulcers.
After developing an education plan for staff, nurses, as well as nonlicensed staff, they received inservices on the new standard of care/practice for pressure-ulcer prevention and treatment, as well as proper documentation of pressure ulcers. Twenty-four hour turning schedules were printed, laminated and placed over every bed as needed. Wound and pressure-ulcer manuals were developed for all nursing units, providing a readily available resource. The Skin Care Committee continues to complete quarterly pressure-ulcer prevalence studies.
"Our pressure-ulcer prevalence data is compared to Patients First NQF Nursing-sensitive Care Performance Measures, which is publicly reported," said Marcia Liggin, RN, NEA-BC, senior vice president/CNO of Southcoast Hospitals Group. "Our pressure-ulcer rate for 2007 was 2.39 percent in adult med/surg, compared to 5.8 percent in other Massachusetts hospitals of the same size. In adult critical care, step-down and surgical areas, the pressure-ulcer prevalence rate was 0 percent."
Other Disciplines Involved
The Skin Care Committee works with other disciplines to achieve the best possible outcomes for Charlton Memorial's patients. One significant achievement was the reduction of stage II coccyx pressure ulcers in frail elderly fractured-hip patients. On admission to the surgical unit, all fractured-hip patients have a hydrocolloid dressing applied to the coccyx as a prophylactic measure. The nursing and physical therapy staff use a gel cushion when the patient is sitting in a chair.
These two measures have significantly decreased the number of nosocomial pressure ulcers that occur in this population. It is gratifying to know we can effect such positive changes in our patients. It's empowering."
Skin Care Committee members receive ongoing education from the WOC nurse, dietitian, physical therapist, pharmacist and company/product representatives and by attending conferences. The committee members work closely with the physician, physical therapist (for whirlpool therapy), pharmacist (for pain management), and the dietitian (for maximizing wound healing). They also act as a resource to nursing staff and physicians.
The WOC nurse chairs monthly meetings of the committee and plans the agenda. Each meeting is structured with an educational component welcoming interdisciplinary speakers.
Outside vendors often present new techniques or products to the Skin Care Committee. Many of these programs provide members with nursing contact hours. The Skin Care Committee members are responsible for sharing this information on the patient care units, and one member also represents the Skin Care Committee at Nursing Council meetings.
Programs Earns Award
In 2005 the University of Massachusetts, Dartmouth, awarded Charlton Memorial's Skin Care Committee with the prestigious "Partners in Caring" award for innovation and creativity in caring for people with chronic illness. Through joint efforts, the Skin Care Committee continues to exceed expectations and achieve positive results. n
Diane Peckham is a WOC nurse at Charlton Memorial Hospital, Fall River, MA.