RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Assessment & Management of Stage I to IV Pressure UlcersEvaluation & MonitoringOrganizations implementing the recommendations in this nursing best practice guideline are advised toconsider how the implementation and its impact will be monitored and evaluated. The following table,based on the framework outlined in the RNAO Toolkit: Implementation of clinical practice guidelines(2002c), illustrates some suggested indicators for monitoring and evaluation:Structure Process OutcomeObjectivesTo evaluate the supportsavailable in the organizationthat allow for nurses toappropriately assess andmanage pressure ulcers.To evaluate changes inpractice that lead towardsimproved assessment andmanagement of pressure ulcers.To evaluate the impact ofimplementing the recommendations.Organization/Unit■ Review of best practiceguideline recommendationsby organizationalcommittee(s) responsiblefor policies/procedures.■ Availability of pressuremanagement supportsurfaces for use by clientsidentified at risk for pressureulcer development.■ Modification to policies/procedures consistent withthe recommendations of thebest practice guideline.■ Presence of a process to monitorincidence/prevalence of pressureulcers within the practice setting.■ Decrease in incidence/prevalenceof pressure ulcers within thepractice setting.Nurse■ Availability of educationalopportunities re: pressureulcer assessment andmanagement withinorganization.■ Number of nurses attendingeducational sessions re:pressure ulcer assessmentand management.■ Availability of ongoingsupport for clinicalapplication of educationalcontent.■ Percentage of nursesself-reporting:• Adequate assessment ofclient risk for developingpressure ulcers.• Monitoring the healingprocess of existingpressure ulcers.• Documenting stage,location and size of existingpressure ulcers.• Need for positioning/support surfaces forclient with, or at risk of,pressure ulcers.• Assessing and documentingthe client’s experience of painrelated to pressure ulcer andits care.■ Evidence of documentation inclient record consistent with theguideline recommendationsregarding:• Assessment• Positioning/Support Surfaces• Ulcer Management• Patient Teaching• ReferralClient■ Client reports painrelief/reduction related topressure ulcer care.■ Client reports dischargeteaching appropriate tohis/her care needs andsetting of care.■ Reduction in wound volume/area/depth (healing wound).■ Absence of Stage I pressureulcers (prevention).■ Referrals to professionals withexpertise in pressure ulcer careas appropriate.FinancialCosts■ Wound care products andauxiliary supplies.■ Support surface expenses.■ Length of stay.■ Nursing human resourceexpenditures related topressure ulcer prevention,assessment and management.54