Project 1: Hospital-acquired Pressure Ulcer
Our HAPU rates on Unit A have risen significantly over the past 6 months. We have a Wound and Skin Care Nurse (WSCN) who has training in wound care. This nurse does not have a Master’s degree or specialty certification in this area but does have a lot of experience. The Wound and Skin Care Nurse is scheduled to work from Monday through Friday, 8a-5p. The WSCN nurse visits every unit and asks about each of our patients. If we identify someone as having a red spot or a potential area of breakdown, we let her know during her rounds.
The WSCN visits patients daily if they are on a computer-generated list of patients at risk for skin breakdown. The list is created when a box is checked in the computerized charting skin assessment area that asks if the patient is on bed rest or is unable to move independently. If a ‘yes’ is checked then the patient’s name is automatically placed on the list. In addition, the computerized Braden Scale is added to the patient’s documentation. The WSCN downloads the list every morning. If someone is identified at risk during the day shift the WSCN does not know about it until the next day.
The WSCN spends a lot of time on our unit. We sometimes have a problem when a patient needs to be seen by the WSCN but do not appear on the list. The nurses do not see the list, only the WSCN nurse. Our current process is to perform the Braden Scale upon initial admission assessment, then once a day if the patient is noted to be at risk, usually during the midnight shifts. The information is entered into the electronic chart (documentation system). We can track the patients’ progress and see what treatments are given to the patient. For the most part, the WSCN does all the treatments unless we are given specific instructions about an individual patient. We are not aware of what evidence supports any of the treatments. Because we have a WSCN, the direct care nurses are not familiar with how to care for the patient with skin breakdown unless the WSCN provides specific directions. We need to know what the best practices are for caring for a patient with a HAPU, including nurse driven care versus what the WSCN does for the patient.
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