New Hanover Regional Medical Center shared governance and clinical ladder projects enabled nurses to reduce pressure injuries through evidence-based TED hose and SCD improvements.
Best Practice: Prevention of Pressure Injuries, New Hanover Regional Medical Center
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. In turn, these projects result in improved patient care and satisfaction, increased nursing knowledge, and more efficient processes. This particular project also happened to reduce hospital cost.
The Challenge of Hospital-Acquired Skin Injuries
When a patient is admitted to the hospital, staff must not only care for the admission problem but also prevent complications from developing. One commonly found problem involves skin issues, such as moisture-related injuries, skin tears, and pressure injuries. These conditions increase the length of hospital stay and hospital cost. Moreover, they increase patient pain and suffering, cause additional morbidities, and reduce overall satisfaction and quality of life.
While patient health and quality of life are of utmost importance, the cost of skin injuries also concerns hospitals and healthcare systems. The Centers for Medicare and Medicaid Services have deemed “preventable” both the development of new pressure injuries after hospital admission and the worsening of a pre-existing pressure injury. Therefore, if either condition develops during a patient’s admission, treatment will not be reimbursed.
Identifying the Problem Through Data
To monitor and track pressure injuries, staff conduct quarterly pressure injury studies using the National Database of Nursing Quality Indicators guidelines. These results compare like units across the nation and identify patient outcomes. In 2016, New Hanover Regional Medical Center staff identified ten newly acquired pressure injuries. Additionally, staff began tracking the acquisition of pressure injuries on each unit.
By December of 2016, the Adult Inpatient Surgery Unit (AISU) had gone a maximum of 60 days without acquiring a unit-acquired pressure injury. A 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 less effective at preventing deep vein thrombosis than the thigh-length option. Nevertheless, the literature did show more patient compliance with the knee-length hose, making it more effective in practice.
Gaining Physician Support and Implementing Change
The nursing team presented this research data to many surgeons for their input, comments, and concerns, and eventually presented it at the General Surgeons meeting. After the research had been summarized, nursing staff recommended that NHRMC implement knee-length hose as the standard, 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 on AISU to ensure equipment availability and decrease delays in implementing interventions. Previously, staff had to order machines from central sterile.
Addressing Fit and Education Gaps
Beyond the knee-versus-thigh-length question, 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 was available. As a result, none of the nurses surveyed could accurately describe how TED hose should be properly fit. The team addressed this gap by providing proper measuring equipment along with the education to use it. Consequently, 90% of surveyed staff could properly identify the process for measuring TED hose and locate the proper equipment.
Overall, 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 involved staff from many different departments, including other nursing staff and nurses’ aides, physicians, and staff from distribution, central sterile, and physical therapy. Furthermore, the results provide a standard of patient product placement, more efficient use of staff time, and a substantial reduction in cost to the hospital.