Date Available

5-6-2015

Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Advisor

Dr. Melanie Hardin-Pierce

Committee Member

Dr. Karen Butler

Co-Director of Graduate Studies

Jennifer McCord

Abstract

Objective: To implement a Hospital-Acquired Pressure Ulcers (HAPU) prevention program utilizing an assessment tool to identify patients at risk, and intervene with a sacral Mepilex® dressing. Our aims are to determine if a change in nursing knowledge and change in nursing behavior after implementing our program.

Background: HAPUs are a significant problem in patient care and healthcare organizations must implement prevention protocols to reduce HAPU prevalence. Guidelines for implementing HAPU prevention programs suggest use of a validate risk assessment tool and initiating preventive interventions. One intervention found in the literature is the adjunctive use of prophylactic Mepilex® dressings to sacral skin.

Design: Descriptive study with a prospective one-group pre and post-test design, followed by a retrospective medical record review.

Methods: A HAPU education was disseminated to TriHealth nurses who voluntarily participated in a 15-question test before and after the HAPU educational didactic. A paired t-test was performed to determine a difference in mean pre/post-test scores. After completion of the educational didactic, units with 65% completion were included in a medical record review to determine adherence to nursing clinical behaviors relating to the new policy.

Results: 1,182 nurses completed the pre-test and 1,514 completed the post-test. Paired t-test analysis determined a difference in mean scores before and after our educational intervention, indicating change in nursing knowledge. 65 medical records were reviewed from 5 units at TriHealth. The mean percent completion of required documentation was 62.2%, and an analysis of variance determined a difference in mean percent completion scores between hospitals, but not unit location. Nurses correctly identified at-risk patients in 50.8% of medical records and used a prophylactic Mepilex® dressing; however 16.9% of at-risk patients were missed. The most identified Mepilex® application criteria included age >65 years, mechanical ventilator use, surgical procedures lasting ≥4 hours, and Braden Scale scores <13.

Conclusion: A change in nursing knowledge was evident after our educational didactic, however, our medical record review indicates a failure to consistently follow the HAPU protocol to identify, intervene, and maintain pressure ulcer prevention practices for patients at-risk.

Relevance to Clinical Practice: This HAPU prevention protocol may be successful at changing nursing knowledge, but had variable impact on changing nursing behaviors. Additional program evaluation is needed to identify areas to support our nurses for long-term sustainability.

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