Skin Resource Manual
Each quarter, as a member of the Skin Champions for Change Committee, a National Data Quality Indicator (NDNQI) survey is conducted hospital wide to average our prevalence of pressure ulcers. During the 3rd quarter of our NDNQI Pressure Ulcer Survey we were found to have 40% incidence of pressure ulcer in the Cardiac ICU. This was a significant increase in comparison to the 1st and 2nd quarter surveys done in 2012. Since that time we have gained many new staff memebers, and I wanted to assess the knowledge of our unit as a whole on skin care concepts and interventions.
I conducted an anonymous survey on surveymonkey.com asking nurses on our unit about their knowledge and comfortability with skin care. I wanted to understand better where to focus my teaching efforts in order to make the most impact in prevention of future pressure ulcers.
After conducting the survey I found that there was a general lack of confidence in the topic of Skin Care, and the resources which were available. I also found there was some inaccurate knowledge regarding a special turning therapy that some Intensive Care Unit beds have called Continuous Lateral Rotation Therapy (CLRT). Some nurses thought that these beds were designed to turn patients at risk for pressure ulcers, and therefore manual turning was less important. After perfoming a "Root Cause Analysis" looking at contributing factors for patients who had developed pressure ulcer during their stay, it was found that this CLRT therapy bed was directly contributing to patient who were getting pressure ulcers.
After taking the survey results into consideration it seemed it would be beneficial for our unit to have a Skin Resource Manual that contained information regarding staging of ulcers, intervention algorithms, and information regarding the types of products we use. Much of this information is located on the University of Colorado HUB, however, many nurses felt like they didn't have easy access to this information. Included in this resource manual was the handbook regarding our special ICU beds, and our specific hospital's policy and procedure. I introduced staff to this new Skin Resource Manual at the September 2012 staff meetings, and was able to personally answer questions that staff had regarding specific issues and situations. I then conducted a study after the Resource Manual had been available to staff for approximately 3 months.
I conducted an anonymous survey on surveymonkey.com asking nurses on our unit about their knowledge and comfortability with skin care. I wanted to understand better where to focus my teaching efforts in order to make the most impact in prevention of future pressure ulcers.
After conducting the survey I found that there was a general lack of confidence in the topic of Skin Care, and the resources which were available. I also found there was some inaccurate knowledge regarding a special turning therapy that some Intensive Care Unit beds have called Continuous Lateral Rotation Therapy (CLRT). Some nurses thought that these beds were designed to turn patients at risk for pressure ulcers, and therefore manual turning was less important. After perfoming a "Root Cause Analysis" looking at contributing factors for patients who had developed pressure ulcer during their stay, it was found that this CLRT therapy bed was directly contributing to patient who were getting pressure ulcers.
After taking the survey results into consideration it seemed it would be beneficial for our unit to have a Skin Resource Manual that contained information regarding staging of ulcers, intervention algorithms, and information regarding the types of products we use. Much of this information is located on the University of Colorado HUB, however, many nurses felt like they didn't have easy access to this information. Included in this resource manual was the handbook regarding our special ICU beds, and our specific hospital's policy and procedure. I introduced staff to this new Skin Resource Manual at the September 2012 staff meetings, and was able to personally answer questions that staff had regarding specific issues and situations. I then conducted a study after the Resource Manual had been available to staff for approximately 3 months.
I first started by sending an email to all RNs in the Cardiac ICU requesting them to complete a survey related to skin and the products we use at the University of Colorado Hospital
This was the survey I created through surveymonkey.com
Feedback from Paula Gipp, the Lead Certified Wound Ostomy Care Nurse and head of the Skin Champion Committee regarding the above survey
This is the 10 question survey I created and the response summary generated by surveymonkey.com
Results
After making this survey available to all the RNs on the Cardiac ICU and gathering the results of the survey I was better able to focus my education around topics that were relevant to the staff and their specific learning needs. The answers I received for questions 1, 2, and 3 led me to believe that staff on the CICU needed more confidence in identifying differing types of skin issues and more information on staging pressure ulcers based on their level of severity. The answers received from questions 4 and 5 showed me that staff needed some reinforcement on where to chart non-pressure ulcer issues which included skin tears and dermatitis from incontinence. Question 6 showed me that most people feel they have a low to moderate understanding of wound care products, an area I would hope to have been higher. Questions 7 and 8 showed me that the majority of staff understand there is a difference in skin issues, and what the University of Colorado Hospital's policy is in reporting skin issues. Questions 9 and 10 really helped me to understand our staff's knowledge on bed functioning related to skin breakdown. I noticed that our staff seemed to be generally misinformed about the different surfaces and their purpose in treating and preventing ulcers. I noted this to be an area specifically important in relation to our newly acquired pressure ulcers during our 3rd quarter survey.