Pearls for Practice: Optimizing Pressure Ulcer Care: A Checklist for System Change

     Our healthcare system sought to enrich and improve strategies to assess, document, and prevent pressure ulcers and to identify key personnel to implement these strategies. An evaluation of our practices yielded the following recommendations:

     1. Assess policies and procedures relevant to documentation systems, risk assessment tools, prevention techniques, and skin assessment documentation along with ease of understanding, thoroughness, accuracy of terms, and incorporation of current evidence-based information.

     2. Ensure documentation systems require thorough data on skin condition on admission assessment, transfer screening, and discharge planning. Electronic records should automatically calculate risk assessment and flag specific intervention algorithms.

     3. Evaluate pressure ulcer risk daily in addition to on admission, transfer, and deterioration of condition. Results should be incorporated into daily documentation of critical care units.

     4. Continually re-evaluate applicable policies and procedures when skin integrity is compromised.

     5. Educate all staff on all shifts on prevention, skin assessment, staging, products, and documentation. All staff need to recognize deviations from the norm and front line caregivers additionally need to know where, how, and when to examine (eg, patient positioning, use of flashlights, palpation for induration, and local temperature). Rolling, continuous inservice and demonstration of competency for both nurses and primary care providers may be required.

     6. Establish documentation standards, including photographs, for wound assessment.

     7. Include inventory of product types, quality of products used, evidence-based efficacy, appropriateness, and cost effectiveness in any product evaluation. Support surfaces should be reviewed for age, condition, warrantee and service contract, and appropriateness for refurbishing or replacement. Managed care reimbursement is a consideration when assessing continuity of products on discharge or transfer.

     8. Foster continuity of care — unit-to-unit within the facility as well as inpatient to outpatient. Patient discharge and transfer documentation should include skin condition as well as medications, treatments, and advance directives. Referral networks should include consideration of equipment and follow-up with appropriate agencies and/or clinicians.

This checklist was part of an abstract presentation at the World Union for Wound Healing Societies in Toronto, June 2008. This article is not intended by the authors to be an endorsement of the sponsor’s productsPearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process. ©2009 Jeffrey M. Levine and Sarah Lebovits. All rights reserved. This checklist was part of an abstract presentation at the World Union for Wound Healing Societies in Toronto, June 2008.

This article is not intended by the authors to be an endorsement of the sponsor’s products.