Best Practice, New Hanover Regional Medical Center

Best Practice: Improving Patient Skin Care & Reducing Pressure Injuriessmlaura Best Practice, New Hanover Regional Medical Center, Wilmington, NC

Meagan Jones, RN-CMSRN, is a Staff Nurse at New Hanover Regional Medical Center Surgery Navigation Center.

Within the shared governance framework at New Hanover Regional Medical Center, nurses are encouraged to engage in clinical ladder projects which, in turn, result in improved patient care and satisfaction, increased nursing knowledge, and more efficient processes.  This one happened to reduce hospital cost as well.

When a patient is admitted to the hospital, staff is not only expected to care for the patient’s admission problem, but to also avoid the development of complications. One commonly found problem is the development of skin issues, such as moisture-related injuries, skin tears, and even pressure injuries.  These conditions not only increase the length of hospital stay and hospital cost, but they also increase patient’s pain and suffering, cause additional morbidities and other complications, and reduce their overall satisfaction and quality of life. While a patient’s health and quality of life are of utmost importance, the cost of skin injuries is also very concerning to hospitals and healthcare. The Centers for Medicare and Medicaid Services have deemed “preventable” not only the development of new pressure injuries after hospital admission, but the worsening of a pre-existing pressure injury as well.  Therefore, if either such condition develops during a patient’s admission, treatment for such will not be reimbursed.

In an effort to monitor and track pressure injuries, quarterly pressure injury studies are conducted using the National Database of Nursing Quality Indicators guidelines. The results are intended to compare like units across the nation, as well identify patient outcomes. New Hanover Regional Medical Center staff identified ten newly acquired pressure injuries in 2016. In addition, staff began to track the acquisition of pressure injuries on each unit. In December of 2016, The Adult Inpatient Surgery Unit (AISU) had gone a maximum of 60 days without acquiring a unit-acquired pressure injury. Review of the prevalence studies indicated that thigh-length SCDs/TED hose contributed greatly to the pressure injury rate.  However, thorough research revealed that the knee-length option was NOT any more statistically effective at preventing deep vein thrombosis than the thigh-length option on their own. Nevertheless, the literature did show more patient compliance with the knee-length hose, making it more effective.

This research data was taken to many surgeons for their input, comments, and concerns, and eventually presented at the General Surgeons meeting. After the research had been summarized to the physicians, nursing staff recommended that the standard for NHRMC would be to implement knee-length hose, unless otherwise ordered by the physicians. All physicians agreed, and the standard was implemented.  In addition, one SCD machine was permanently placed in each patient room (vs the old standard of having to order from central sterile) on AISU to ensure availability of equipment and to decrease delay of implementation of such interventions.

In addition to logistics of knee vs length, surveys revealed that other issues surrounding TED hose originated from improper fit and improper assessment by nursing staff.  Before this project, no measuring equipment or instruction on how to complete a proper fitting of TED hose was available.  None of the nurses surveyed were able to accurately describe and determine how TED hose should be properly fit. This was addressed by providing proper measuring equipment, as well as the education to do so, resulting in 90% of surveyed staff being able to properly identify the process for measuring TED hose and determine where proper equipment to do so was located.

Overall, I believe this project was very successful on many levels. It not only provides better patient results, but also supplies nurses with additional tools and education needed to deliver the best care.  The project included involved staff, as well as collaborated with many different departments, such as other nursing staff and nurses’ aides, physicians, and staff from distribution, central sterile, and physical therapy.  The results of the project not only provide a standard of patient product placement, but more efficient time of staff and a substantial reduction in cost to the hospital.