Eyes on Skin: Electronic Documentation of 2 RN Skin Assessment to Support Evidence Based Practice and Nursing Documentation for the Prevention of Pressure Injuries

Evidence-based nursing interventions to prevent pressure injuries are well known. Yet, a significant number of pressure injuries still occur. Important components to sustain pressure injury prevention are standardized processes.

Studies have indicated that implementing a 2 RN skin assessment has resulted in a decrease of hospital-acquired pressure injuries. A 2-person skin assessment upon admission builds a foundation for pressure injury prevention and promotes quality patient care by prioritizing the assessment of skin and prevention of injury.

Clinical Nurse Champions working in a community-based hospital embraced the concept of a 2 RN skin assessment. A pilot project was developed and tested on 4 medical units. The results were encouraging, with improved skin assessment prioritization and teamwork for pressure injury prevention. The hospital pressure injury prevention and wound care team recognized the benefits of this process. They then garnered support of the organization’s nursing shared governance council for a hospital-wide implementation. The team worked with Nursing Informatics to develop the EYES ON SKIN electronic documentation screens in the electronic medical record.

The EYES ON SKIN flowsheet appears in both the admission and transfer screens of the hospital electronic medical record. The flowsheet guides nurses to describe skin abnormalities, wounds, and pressure injuries present on admission with a second RN confirmation. If a patient is determined to be at risk for a pressure injury, technology provides a best practice advisory for pressure injury prevention and links to open the risk for pressure injury care plan and nursing order set for pressure injury prevention.

Nursing staff have embraced this process hospital wide. Documentation compliance was 83.25% 1 month after implementation and 96% at 6 months. The success of this project highlights the power of partnerships to improve patient outcomes.

References

1.  Spader, C. (2018).  Critical care of the skin: two-person skin assessment builds a foundation for pressure injury prevention.  American Nurse Today. 2018;May:17–18.

2.  Boyes C, Sederstrom J . 2 RN skin assessment for the prevention of hospital acquired pressure injuries.  Poster presented at: Wound, Ostomy, Continence Nurse Conference; June 3-6, 2018; Philadelphia, PA.

3.  Salicki A, Dion A. Four eyes within four hours: a quality improvement project to decrease Hospital Acquired Pressure Ulcers. Poster presented at: Hartford Hospital, Hartford, CT; 2016; www.hartfordhospital.org