APN role in Pressure Ulcer improvement

[umichnurse]

Hello everyone!

I am taking this Advanced Practice Role course in grad school this semester and

I basically have to come up with an "Innovative, creative strategy" to improve pressure ulcer in elderly population as a nurse practitioner. I have to present strategies as a NP, not as a RN, and list things that I could do for patients with pressure ulcer and/or nurses who provide care to the patients who have pressure ulcer.

I read something about establishing a bell system every 2 hours in every patient's room, but then I had a difficulty how to implement that at a nursing home, or a long-term care facility. As a nurse practitioner, should I just talk about educating nurses and making sure the use of assessment tools, etc.?

Do you have any idea for this paper/presentation?

Thanks for your time!

[highlandlass1592, BSN, RN]

Ok, I have to ask: are you a staff nurse at U of M??? Wondering if I work with you. :-)

As for implementing a turning strategy in an ECF: back when I was a nursing assistant, we had a plan that patients in odd numbered rooms got turned on odd hours, even number rooms on even hours. Staff then had a sign in sheet in the individual rooms to sign with the exact time of the turn and your initials.

If you are looking to implement a bell system, I'd think it would need to be done using the speakers for paging. We had something similar when I started but they switched to the system I just shared as the chimes got a bit confusing.

Problem with turning schedules is they are staff dependent. If you are the only aide on a hallway with 30 patients, 15 completes, you do the best you can. You can forget having someone take the time to sign in all those rooms.

[highlandlass1592, BSN, RN]

You know, just re-read your post. You mentioned as well providing education for nurses who utilize pressure ulcer care. I'm not sure but seems like preventing EBP in an education form would also qualify. Providing an inservice regarding best, current practices would be a great idea,if your instructor approves. The facilities I've worked at in the past had some really interesting treatments that didn't do anything to help prevent ulcers. So that might be an avenue to consider as well. Getting with someone certified in wound care mangaement might provide you with the resources you need to provide appropriate education. The turning strategy could come out of that education.

[umichnurse]

You guys are awesome!

This course requires me to create an innovative and creative strategy and I am so NOT creative, so it's a difficult topic. Educating nurses and nurse aides with EBP would definitely work, I'd look into to the chime system closely, since this might involve the whole health care team, and the budget issue as well. I like the idea of turning patients in odd/even hours :)

What do you all think about the assessment tools? What measurement tools are you using at your unit or have you used before? Is Braden the most popular one?

p.s. I go to u of m and am actually looking for a RN position at the UMHS.

[RedhairedNurse, BSN, RN]

Nutrition and albumin levels is an important factor in preventing and treating pressure ulcers. Our wound care nurse recently had an inservice about this issue and nutrition was really stressed upon as being a very important factor in preventing/healing wounds.

We use the braden score.

As the nurse, if we have a patient we feel is at risk for skin breakdown, we will get an order from the MD for weekly albumin levels. Along with turning q2, we will provide the extra nutrition needed for prevention of decubs.

[highlandlass1592, BSN, RN]

Definitely have used Braden, seems to be the standard at every hospital I've worked at.

Redhaired nurse spoke of using albumin levels. In critical care, we look at pre-albumin as almost every patient has a comprimised albumin level due to their illnesses. And her post brought up another good point to consider, talking to a registered dietician. Again, as I work in critical care now, I'm most comfortable sharing that data: an RD rounds on each patient in the ICU at least weekly. They will comment on wound healing (including pressure ulcers) and will make calorie and protein recommendations. That might also be an area to inservice on, nuitritional aspect of patients with pressure ulcers/ comprimised wound healing. Taking in ALL the factors of these patients (Diabetes, renal failure, for example) can lead to some creative ways to come up with adequate nutrition.

Good luck to you at U of M. It's a great place to work. Of course, I'm biased.

[NotFlo]

The front desk person pages over the intercom every two hours to the staff that it's time to turn and position. I guess it's a good reminder but honestly I don't even notice or hear it most of the time after having heard it so often. Plus, it's really hard for the CNAs and nurses to literally drop what they're doing to run and turn and position people. I don't know what the answer is but I don't think the overhead paging really works.