Best Practices

Building an effective pressure ulcer prevention program

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

As a wound care nurse, do you feel the weight of the world on your shoulders when trying to implement a pressure ulcer prevention program? Many staff members think it’s up to the wound care nurse alone to implement the program. However, a successful program requires involvement from all staff and is a 24/7 endeavor. Here’s how to do it.

Gather the best and brightest

The first step is to surround yourself with key staff and other clinicians to help you lead and implement the program. Build an interdisciplinary team that includes, at a minimum, dietitians, therapists, nurses, nursing assistants, physicians, and nurse practitioners. Be sure all shifts are represented.

Nursing assistants are the ones who implement preventive interventions, so they form the foundation of your team. Give them a strong knowledge base on interventions that will help prevent pressure ulcers. Empower them to organize their shifts and roles to ensure interventions are implemented and communicated.

Other key team members you might not think to include are representatives from housekeeping and maintenance. When cleaning the room, housekeeping staff can confirm that the correct mattress is in the correct patient room and ensure the support surface is plugged in. In an emergency situation, maintenance staff should be able to troubleshoot product problems until the manufacturer can respond.

Finally, don’t forget representatives from restorative nursing; the more mobile your patients are the less likely they will develop pressure ulcers.

Establish a system

Set up regular meetings to discuss skin integrity; it’s best to keep the meetings to a consistent time and day of the week to facilitate attendance. Move the meeting past simply reviewing patients with wounds to taking a proactive approach. Review patients who are at high risk for pressure ulcers and ensure they have appropriate preventive interventions in place.

Engage in ongoing monitoring to ensure interventions such as heel elevation are being implemented. If possible, the wound care nurse should perform monthly random audits of the following:

  • medical records and care plans of a few high-risk patients on each unit to ensure risk assessments and care planning are appropriate and per policy.
  • spot check of some new admissions to ensure interventions are in place within 24 hours of admission.
  • review of treatment records to ensure accurate transcription and a signature that treatment orders have been completed.

It’s also important to set up pressure ulcer prevention education for all staff during orientation and at least yearly. Ensure at least 70% of staff attend the education sessions. Have fun with education, make it interactive, and involve therapy, dietary, maintenance, and housekeeping staff.

It takes a team

No pressure ulcer prevention program will be successful if the mindset of staff is that it’s entirely up to the wound care nurse. A successful program involves multiple disciplines and representatives from all shifts to ensure patients don’t develop skin integrity issues.

Jeri Lundgren is vice president of clinical consulting at Joerns in Charlotte, North Carolina. She has been specializing in wound prevention and management since 1990.

Disclaimer: The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, Wound Care Advisor. All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

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