QSEN Simulation Pressure Ulcer Assessment

1. QSEN SimulationPressure Ulcer Assessment Stacey Johnson BSN, RN Bethel College MNUR 613

2. Pressure Ulcers • Common problem • Reduce quality of life • Indicator of quality of care • Assessment requires a multidisciplinary approach

3. Learning Outcomes • Cognitive • Outlines the factors involved in development of a pressure ulcer. • Affective • Discusses the importance of a holistic approach to pressure ulcer assessment. • Psychomotor • Describes the pressure ulcer using NPUAP guidelines.

4. Scenario • 75 year old male • Fractured hip • History of cognitive impairment • Frequently incontinent • Weight loss • Developed a pressure ulcer to coccyx

5. Roles • Family member • Nurse • Nursing assistant • Dietician Time • Scenario 20 min • Debriefing 20 min Equipment Needed Wound mannequin Centimeter wound measuring device Sterile cotton swabs Gloves Educational material

6. Measurement • Length x Width x Depth • Length- head to toe • Width- side to side • Depth- deepest part of wound using sterile cotton swab Assessment Procedure Wash hands and put on gloves. Describe location of the wound Describe drainage type and amount Describe skin surrounding the wound Assess for s/s infection Measure the wound Document

7. Educate the patient and caregiver on treatment and prevention strategies • Provide physical and emotional comfort QSEN Competency Patient Centered Care Knowledge- Empower patient and family through education Skills- Assess for presence of pain Attitude- Value nurses role in relief of pain

8. Nursing • Nursing Assistant • MD • Dietician • Social Service • Therapy QSEN Competency Teamwork & Collaboration Knowledge-Describe how teamwork improves outcomes Skills-Assumes the role of team member in treatment of pressure ulcer Attitude-Values teamwork

9. NPUAP Guidelines • AMDA Guidelines • National Clearinghouse QSEN Competency Evidence Based Practice Knowledge-Describes guidelines for pressure ulcer assessment Skills-Locate clinical practice guidelines for pressure ulcers Attitude-Values evidence based practice

10. CMS QSEN Competency Quality Improvement Knowledge-Recognizes the importance of prevention of pressure ulcers in quality care Skills-Uses quality measures to evaluate care Attitude-Values contributions to improve outcomes related to pressure ulcers

11. Turning and repositioning q 2 hours • Infection control • Toileting programs • Monitoring for incontinence • Use of support surfaces • Educating nursing assist staff QSEN Competency Safety Knowledge- Describes a culture of safety in prevention of pressure ulcers Skills-Communicates observations related to plan of care being followed Attitude-Values monitoring of care activities provided by team

12. Electronic health records for documentation • Electronic database for plan of care • On-line slide shows • Internet resources for patient education QSEN Competency Informatics Knowledge-Describe how information technology can improve outcomes related to pressure ulcers Skills-Use technologies to communicate care plan and uses internet resources Attitude-Value nurses role in implementation of technology for improvement of pressure ulcers

13. Debriefing • Explains nursing interventions to prevent and treat pressure ulcers. • Uses evidence based guidelines to measureand describe wound. • Discusses roles of team members in wound treatment and prevention.

14. References Bloom B. S. (1956). Taxonomy of educational objectives, handbook book I: The cognitive domain. New York: David McKay Co. National Pressure Ulcer Advisory Panel. (2009) Treatment of pressure ulcers: Quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel. Jankowski, I,M.(2010). Matching patient safety goals to the nursing specialty. Using wound, ostomy, continence nursing services. The Journal of Nursing Administration, 40(1), 26-31. Jaul, E. (2010). Assessment and management of pressure ulcers in the elderly. Drugs and Aging, 27(4), 312-325. Sterner, E., Lindholm, C., Berg, E., Stark, A., & Fossum, B. (2011). Category I pressure ulcers how reliable is clinical assessment? Orthopaedic Nursing, 30(3), 194-205.