Wound Care Technology Fosters Communication/Collaboration Among Nurses and Physicians

Abstract

ulcers and treatment negatively affect not only the physical, emotional and spiritual health of the patient, but also increase length of inpatient stay and costs. In compliance with the IHI Protecting 5 Million Lives campaign and the emphasis on wound care in 2008, BWMC tasked the Skin Care Committee to further improve prevention of pressure ulcers. The challenge was to decrease hospital acquired pressure ulcer development and to create user friendly screens and menus in the electronic record. Initially we explored ways to reduce the number of Stage I heel pressure ulcers by implementing a "Heels Up" Campaign. The next hurdle was to streamline the documentation. We explored a way to capture and take action in preventing ulcer development in patients at risk. Using a trigger Braden score of 18 or less, the CNS team developed an "APPLE" model that prompts the nursing team to implement preventative measures proactively. A red apple appears on the nursing task list when a Braden score of 18 or less is documented. This apple is a visual reminder to implement the nursing protocol for alteration in skin integrity. The campaign included a red apple pin to place on each name badge to further reinforce the reminder. Initial results and compliance with the improvements was demonstrated. The challenge is to assure that this improvement is sustained over time with the electronic screen changes and the visual prompts. By increasing the sensitivity of the Braden score from 16 to 18 as a trigger for action, we predict that the rate of hospital acquired pressure ulcers will decrease and remain low as we continue into our prevention efforts.STUDY AIM: The overall objective of this study is to determine the prevalence and nosocomial incidence of incontinence associated dermatitis (IAD) among long-term acute care (LTAC) patients. BACKGROUND AND SIGNIFICANCE: Recent literature suggests many reported Stage I and Stage II pressure ulcers actually may be attributable to IAD. In March 2005, a pilot prevalence study of IAD and perineal skin injury was performed in acute care facilities in the United States (Junkin, 2005; 2007). In this study, among patients with more than one perineal skin injury, IAD and pressure ulcers were the most frequent combination. To our knowledge, there are no published reports of IAD prevalence/incidence in the LTAC population. STUDY DESIGN: This was a cross sectional observational cohort study. Data was collected as a component of standard protocol skin inspections performed by the wound team at the LTAC. All data was collected within a 24-hour period from February 20-21, 2007. Data collection was observational and performed using a modified version of the data collection tool devel-oped by a company* that markets perineal skin care products. STUDY POPULATION: Ninety-six patients were present and eligible for data collection. Refusal to participate in the study or inability to gain consent for participation resulted in exclusion of 16 patients. Data was obtained from 80 participants. STUDY RESULTS: Data curren...