Image: Members of Montefiore's nursing staff, trained in wound management and skin integrity, turn a bedridden patient.Contacts
Christine Greenidge, DHA, APRN, BC
Professional Practice (Moses Division)
Nursing Quality Officer
cgreenid@montefiore.org
Leslyn E. (Eva) Williamson, RN
Director of Nursing, Medical Care Center and Services (Moses Division)
lewillia@montefiore.org
Strategy
Pressure ulcers, commonly known as bed sores, are flesh-killing infections resulting from skin breakdown in areas where the body rests for too long without shifting weight. The prevention of this potentially fatal condition has been identified as a primary quality improvement initiative by the Centers for Medicare and Medicaid Services. As part of this effort, hospitals, home health agencies, and emergency services have been encouraged to collaborate to identify and reduce causes of bed sores, many of which begin to develop before patients enter nursing homes.
Beginning in 2006, in response to the Joint Commission's recommendation, all Montefiore Medical Center nursing staff reviewed the pressure ulcer prevention and treatment policy and took part in training regarding assessment, intervention, measurement, location, staging, treatment, and documentation of bedsores. Training initiatives have included:
- Skin integrity and wound management classes
- Wound care symposium for employees and other health care professionals
- Wound care e-learning module
- Pressure ulcer prevention and treatment in new nurse orientation
- Unit-based pressure ulcer training
In designated units throughout the hospital, Montefiore clinical nurse specialists (CNS) began to conduct rounds on high risk patients, specifically those over age 65 and/or with ventilators, neurological problems, compromised mobility, or known pressure ulcers. The CNSs also reviewed documentation relating to patients' Braden scores (measurement of pressure sore risk), risk factors, consultations, and interventions, and conducted one-on-one staff training where needed.
An aggressive monitoring and assessment protocol has augmented staff training and rounds to further improve patient safety. All cases of hospital-acquired pressure ulcers are reviewed, monthly chart audits are conducted on all units, regular reviews of incidence and policy are conducted at staff meetings, individual counseling sessions are held with staff who fail to meet policy, and the multidisciplinary Pressure Ulcer Committee meets quarterly.
Results
Pressure ulcer prevalence and incidence rates at Montefiore Medical Center are significantly lower than national rates, and since the nursing department renewed focus on pressure ulcer prevention at the end of 2008, rates have fallen further.