Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs.

BACKGROUND: Patients continue to suffer from pressure ulcers (PUs), despite implementation of evidence-based pressure ulcer (PU) prevention protocols. In 2009, Joint Commission Resources (JCR) and Hill-Rom created the Nurse Safety Scholar-in-Residence (nurse scholar) program to foster the professional development of expert nurse clinicians to become translators of evidence into practice. The first nurse scholar activity has focused on PU prevention. Four hospitals with established PU programs participated in the PU prevention implementation project. PU PREVENTION IMPLEMENTATION PROJECT: Each hospital's team completed an inventory of PU prevention program components and provided copies of accompanying documentation, along with prevalence and incidence data. Site visits to the four participating hospitals were arranged to provide opportunities for more in-depth analysis and support. Following the initial site visit, the project team at each hospital developed action plans for the top three barriers to PU program implementation. A series of conference calls was held between the site visits. YEAR 1 PROJECT RESULTS: Pressure Ulcer Program Gaps and Recommendations. The four hospitals shared common gaps in terms of limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices. Detailed recommendations were identified for addressing each of these gaps. these CONCLUSIONS: Recommendations for eliminating gaps have been implemented by the participating teams to drive improvement and to reduce hospital-acquired PU rates. The nurse scholars will continue to study implementation of best practices for PU prevention.

Matching patient safety goals to the nursing specialty: using wound, ostomy, continence nursing services.

With increasing nursing specialization, administrators may not have clear guidelines directing which specialists should be targeting specific patient populations and specific patient care issues. Because pressure ulcers are an important indicator of quality of care, this discussion focuses on selecting the appropriate wound, ostomy, continence specialist to develop and support programs that are designed to prevent pressure ulcers, treat patients with pressure ulcers, as well as management of other types of wounds, stomas, fistulas, incontinence, and skin breakdown. Nurse leaders are in a position to ensure that appropriate resources are available to support the development of hospital programs that will promote safe, efficient, and cost-conscious patient care.