CSI: Complete Skin Inspection – Preventing Pressure Ulcers

Presented by Joan Bageant, BSN, RN, Certified Wound Ostomy Nurse and Sandy Seaton, BSN, RN, Certified Wound Care Nurse

What triggers prompted you to start this project? In April 2009, the Hospital-Acquired Pressure Ulcer (HAPU) prevalence rate spiked to 8.79 per 1000 patient days and compliance with the prevention bundle dropped to 56%.

Why is this topic a priority for your department/organization? Because HAPUs are now considered an indicator of quality of care, they are among the ‘28 never events’ developed by the National Quality Forum, and the Centers for Medicare & Medicaid have added HAPUs to the list of preventable conditions that will not be reimbursed.

What does the literature and other evidence say about your topic? Prevalence rates for HAPUs surpass 15% of inpatients and nearly 60,000 patients die each year from complications due to HAPUs. The average hospital incurs $400,000 - $700,000 in annual direct treatment costs for HAPUs. Pressure ulcer prevention should be provided for all patients at risk for pressure ulcer development and a head-to-toe skin inspection should be done upon admission and at regular intervals.

How did you incorporate this change into practice? Nurses developed a HAPU program that included conversion of physician orders to a nurse-driven protocol, adoption of an acronym, ‘SKIN’, to remind nurses of the key elements in the protocol: Surface selection Keep turning patients, Incontinence management, and Nutrition, education on the Braden Scale and risk assessment, and measurement of compliance and prevalence by rounding with bedside nurses rather than through retrospective chart reviews.

What have been the outcomes of the change in practice? Compliance with the nurse-driven protocols increased to 87% and the prevalence rate of HAPUs at CFVH decreased to 3.1 per 1000 patient days as of June 2010. The elements of the ‘SKIN’ acronym have been incorporated into daily assessment and charting processes.