Evidence Based Research Project

Transcription

1 UC Davis Medical Center Nurse Residency Program Evidence Based Research Project Pressure Ulcer Prevention/Care Lale Johnson Alex Winters Tran-Thu Khuu Kevin Tsui Daniel Burhans

2 PICO Question: Do the current UCDMC policies and procedures reflect the latest evidenced based practice for pressure ulcers and ensure the highest quality of care for patients who currently have or at risk for developing pressure ulcers?

3 The answer is mostly YES!

4 Patients at Risk for Developing or Those with Pressure Ulcers (P & P XII-02) -The Registered Nurse will conduct a skin assessment and pressure ulcer risk assessment using the Braden Scale upon Admission to the hospital and each shift and within 8hrs of a surgical procedure. -Any pressure ulcer findings need to be documented in the medical record -The physician should be notified and a consultation should be initiated for a Wound Care Nurse to stage the pressure ulcer and create a treatment plan. -Prevention is key, having the right kind of bed, turning q2 hours, assessing nutrition needs, etc. -Wound care team is essential in treatment of the wound.

5 Intranet site: staff/woundcare. Site contains information on classification, prevention, and treatment of each type of wound and is a great resource for nurses.

6 Documentation Care What remains to be discovered is the best way to educate nurses to improve their knowledge and promote the highest quality of care for patients. Consultation Staging

7 Risk Factors, Prevention Methods, and Wound Care for Patients with Pressure Ulcers (Pieper, Sugrue, Weiland, Sprague, and Heiman, 1998). There is a deficiency of nursing knowledge in caring for and preventing pressure ulcers. The study followed six-hundred ninety-four patients An oldy but a goody Seventy-one were found to have pressure ulcers that were nosocomial or present upon admission. The study found that only 80% were on a pressure reducing/relieving surface, only 52% had pillows for support, 44% had a lift sheet, 37% had a positioning wedge, 21% had heel protection, and 18% were on a turning schedule. In addition, only 48% of patients had any type of prevention methods charted, and only 44% had a pressure ulcer prevention plan of care. Based on the above findings, the authors concluded that this article raises questions about the serious need to further educate staff about pressure ulcer prevention and care.

8 E-learning in wound care: developing pressure ulcer prevention education (Jones, 2007). Education for healthcare professionals is an important factor in the prevention and management of pressure ulcers. Classroom education can pose a problem for nurses who have families, commute, or do not wish to attend another mandatory class in addition to their work shifts. The author suggests e-learning as an alternative method to both classroom education and in-services during work hours. These online education sessions can review classification, prevention, and treatment of pressure ulcers in a user friendly environment that includes both pictures and interactive slides. The author mentions that further audits and evaluations will be needed to see if this teaching option improves nursing and health care organization knowledge regarding pressure ulcer care and prevention.

9 Best practices in wound care prevention and treatment (Ayello, Baranoski, and Salati, 2006) The authors surveyed 692 nurses from 48 states, five Canadian provinces, and seven other countries. The survey questions were related to best practices in wound care prevention and treatment. One question asked nurses the purpose of the Braden risk assessment tool. It was found that incorrect answers came from those nurses who were both younger and less experienced. Nurses were also asked if their facility had a policy that specified how often a wound assessment should be completed and documented. Again, younger and less experienced nurses and students said they did not know if such a policy existed. In addition, less than half of new nurses surveyed felt they could consistently identify all stages of ulcers, compared to 70% of experienced nurses. These findings suggest a knowledge gap about pressure ulcers and in regards to where informational resources can be found and how to access those resources.

10 Outcomes of a Clinical Nurse Specialist-Initiated Wound Care Education Program: Using the Promoting Action on Research Implementation in Health Services Framework (Capasso et al. (2009). In large teaching hospitals, administrators recognized a gap in the availability of staff who were knowledgeable of contemporary, evidenced-based wound care, especially for off and weekend shifts. To address this problem a twenty person Clinical Nurse Specialist (CNS) taskforce was formed. The CNS taskforce worked to provide wound care resources to nurses on a 24-7 basis, to be more involved with clinicians, and to provide an educational program for staff and advanced practiced nurses. The education class proved successful with average scores increasing between 8 and 20% from pre-test to post-test. In addition, 10% of those who took the class became wound care champions for their units. Overall, the implementations proved successful, yet the authors mention that better evaluation methods should be implemented in regards to nurse knowledge and skill retention of pressure ulcer education learned during the class.

11 Evidence Based Recommendations Create new ways of educating nurses about pressure ulcer prevention and treatment, such as e-learning. Teach student, new graduate, and younger nurses where and how to access resources about pressure ulcers. Implement evaluation methods to determine nurse retention of learned pressure ulcer information. Offer 24-7 pressure ulcer/wound care support for staff nurses through the use of nurse champions and CNS. Provide continuing education classes on pressure ulcer prevention and treatment (i.e. through the CPPN).

12 References Risk Factors, Prevention Methods, and Wound Care for Patients with Pressure Ulcers (Pieper, Sugrue, Weiland, Sprague, and Heiman, 1998). E-learning in wound care: developing pressure ulcer prevention education (Jones, 2007). Best practices in wound care prevention and treatment (Ayello, Baranoski, and Salati, 2006) Outcomes of a Clinical Nurse Specialist-Initiated Wound Care Education Program: Using the Promoting Action on Research Implementation in Health Services Framework (Capasso et al. (2009).