VALHALLA, N.Y. Over the past two years, Blythedale has been working to update and improve wound care protocols. Linda Hurwitz, RN, MS, NEA-BC, chief nursing officer, and certified would care nurses Virginia Andriola, RN, MSN, CPN, WCC, and Noreen McMorrow, RN, CPN, WCC, have been at the forefront of this endeavor, helping to educate staff in the process of wound care assessment, documentation, treatment, and follow-up care.
In 2006-07, we noticed an increased occurrence of children admitted to our facility from ICUs and NICUs with pressure ulcers, Hurwitz says. Although approximately 80% of our children are at risk for developing pressure ulcers, we had an almost nonexistent incidence of pressure ulcers or sores at the facility. We decided that we needed to examine what we were doing right, formalize it, and share it with one another and with others.
The nursing department organized an interdisciplinary task force that examined facility activities and developed protocols, such as pressure mapping, bathing patients in the shower or tub rather than basin baths, meticulous skin care protocols, good nutrition, selection of special surfaces, and more.
Blythedale uses the quarterly Hill Rom pressure ulcer prevalence studies to measure nursing-sensitive outcomes. The Hill Rom data gives administration and staff a comprehensive picture of the patient population, the prevalence of pressure sores, and measures instituted to prevent them. It also shows where administration and staff could make improvements.
Wanting to share their success with others, Hurwitz, Andriola, and Colleen Booth, RN, MS, CPN, director of education, presented a poster session at the annual meeting for the Society of Pediatric Nursing called Children Get Pressure Ulcers, Too! The poster session depicts the steps the hospital had taken to develop the interdisciplinary protocol, the components of the protocol, and the outcomes achieved during a three-year period.Linda S. Hurwitz, RN
Every child at Blythedale is evaluated with the Braden or Braden Q Skin Assessment Scale upon admission and every two weeks during their hospital stay. If the child is at high risk, special orders may be written for a higher level of pressure ulcer protection that may include pressure mapping to special surface selection. Of course, nothing substitutes for the basics of good skin care, including keeping the skin clean and dry and using proper turning and positioning techniques, adds Andriola. Given the fact that patients at Blythedale often need splint readjustments or grow out of the equipment that they are using for support, regular skin assessment is essential.
Realizing that documentation is an essential component of any wound care, Andriola found that the Bates-Jensen Wound Assessment Tool answered their need for a user-friendly way for staff members to measure and differentiate the aspects of wounds.Virginia Andriola, RN
Naturally, treatment depends on the type of wound that the patient presents to us, says Andriola. Since there are more than 3,000 different skin care products out there, its always a challenge to keep up with the marketplace. For example, were trying a special spray to cleanse the skin, rather than using friction for cleaning high-risk areas, and were also trialing for different products to treat incontinent-associated dermatitis, she adds.
Administration and staff have been recognized for all their efforts by the New York Organization of Nurse Executives. In 2008, they received a $1,000 grant for best practices in pressure ulcer prevention. Although we are proud of our positive outcomes, we want to continue to be vigilant, continue to raise awareness of pressure ulcer prevention, and transfer our knowledge to others, says Hurwitz.