Implementing a pressure ulcer prevention program and enhancing the role of the CWOCN: impact on outcomes.

Hospitals in the US are increasingly concerned with the rising number of hospital-acquired pressure ulcers. To reduce its 2002-2003 average hospital-acquired pressure ulcer prevalence rate of 9.2%, a regional medical center in southeastern US initiated a process improvement and education program. Quarterly pressure ulcer prevalence studies were conducted and the Medical Intensive Care Unit was found to have the highest number of hospital-acquired pressure ulcers among the five units participating in the study. As part of a new Pressure Ulcer Strategic Plan, significant changes were made to the organizational infrastructure and processes, which included implementing the Braden Risk Scale Assessment Tool in place of the Norton Risk Scale, developing a pressure ulcer prevention protocol, creating Pressure Ulcer/Skin Tear Physician orders for nurses, establishing a Skin Resource Team, and providing additional education, training, and other relevant resources. Better appreciation for and enhanced utilization of Certified Wound Ostomy Continence Nurses were encouraged. New support surfaces were purchased. Implementing these changes resulted in a decrease in the quarterly hospital-acquired pressure ulcer prevalence in participating units, including the Medical Intensive Care Unit where rates dropped from a high of 29% to near 0%. Clinicians now approach pressure ulcers as preventable rather than inevitable and view Certified Wound Ostomy Continence Nurses as resources and clinical experts for prevention and treatment. Overall quality of care and financial resource utilization also have substantially improved.