March 2008 - CAET - The Canadian Association for Enterostomal ...

Featured Article
E.T. Leadership In Pressure Ulcer Prevention
by Nancy Parslow, RNET
Short Biography: I am presently
the Wound Care Specialty Nurse at
Southlake Regional health Centre in
Newmarket. I am also on the RNAO
development panel for the new
Ostomy Guideline. In the past I was
on the RNAO development panels
for the BPG’s for Risk Assessment
and Prevention of Pressure Ulcers,
Assessment and Treatment of Stage
1-4 Pressure Ulcers, Assessment and
Management of Venous leg Ulcers.
I am also involved on the CAET
certification examination committee
and cirriculum development for the
revised educational program.
Pressure ulcer development
increases length of hospital stay,
complexity of care needs, morbidity
and mortality rates, and suffering
from complications associated
with pressure ulcers (Foster, Frisch,
Denis, Forler, and Jago, 1992). The
use of a program to prevent pressure
ulcers should decrease costs, length
of hospital stay and reduce patient
suffering.
A study conducted across Canada
by Woodbury and Houghton in
2004 identified that the problem
with pressure ulcer development is a
significant occurrence in a variety of
health care settings with an average
prevalence of 26.2 % of patients
having a pressure ulcer.
A review of the evidence presented
in the RNAO Guideline; Risk
Assessment and Prevention of
Pressure Ulcers 2005, estimates
that “10% of patients admitted to
hospital will develop a pressure ulcer,
the elderly are at highest risk with
approximately 70% of all pressure
ulcers occurring in elders. Of those
patients who develop pressure ulcers,
approximately 60% occur in the acute
care setting – usually within the first
two weeks of admission with 15% of
elderly patients estimated to develop
ulcers within one week of admission.
Several studies report mortality rates
32 The LINK - March 2008
as high as 60% for elders with a
pressure ulcer within one year of
discharge from hospital.” (RNAO, pg
20, 2005)
The publication of Best Practice
information such as that developed by
the Canadian Association of Wound
Care (CAWC) and Registered Nurses
Association of Ontario (RNAO) have
created national awareness of the need
to prevent pressure ulcers and has
established standards of care that can
be used as quality of care indicators.
Programs such as the CAWC Pressure
Ulcer Awareness Program, patient
safety initiatives and accreditation
standards stress the necessity of early
intervention for those patients at risk
of developing pressure ulcers (RNAO,
pg. 20- 21 2005). Studies indicate
that the majority of pressure ulcers
are preventable with appropriate
interventions.
The development and implementation
of a formalized program to prevent
pressure ulcers is often confronted
by many challenges that must be
overcome before a change in practice
can be effectively incorporated.
Issues related to staff shortages, lack
of available time, lack of leadership
and support for the creation of a
program may be common roadblocks
to success. Many clinicians struggle to
obtain the resources and support that is
necessary to implement best practices
for pressure ulcer prevention.
I was very fortunate to be selected as
a site champion to pilot the CAWC
Pressure Ulcer Awareness Program
(PUAP) for my community hospital.
The PUAP utilizes a structured team
approach to advocate for Pressure
Ulcer (PU) prevention by providing
a supported, organized program
ready for implementation by the
site champion. The ET nurse who
provides leadership and expertise in
skin and wound management is the
ideal candidate to lead a pressure
ulcer prevention program such
as the PUAP. All site champions
receive mentorship from the
CAWC program leader and other
site champions to support the
development of leadership skills to
overcome challenges and implement
the PUAP program successfully.
This ongoing link to a supportive
network facilitates the development
of creative strategies to manage
adversity and obtain the support
and recognition necessary to
incorporate an interdisciplinary
pressure ulcer prevention program
into everyday practice.
Recognition of the ET nurse as
a leader and expert in pressure
ulcer prevention and management
was enhanced by the role of the
PUAP facilitator. As the various
components of the program were
implemented staff, patients and
families began to identify simple
steps that could be incorporated
into daily routines to maintain
skin integrity without increasing
workload. Colourful posters,
pamphlets, buttons, certificates and
prizes effectively raised awareness
and reinforced goals. Chart audits
and interdisciplinary high risk skin
rounds provided opportunities
for education at the bedside
with staff, patients and families
promoting increased knowledge
and skills. Audits also monitored
progress, promoted accountability
and provided progress reports for
individual units which created
excitement and enthusiasm as each
area strived to improve their patient
outcomes.
Implementation of best practices
promoted a change in patient
outcomes. Re-introduction of the
Braden risk assessment with a
focus on its use as a care planning
tool prompted the development of
individualized plans of care targeted
at interventions to manage the
identified risk factors.
Suite à la page 34/ Continues on page 34.