Pressure ulcers, also known as bedsores or pressure injuries, pose a significant challenge in healthcare settings. They cause patient discomfort, increase healthcare costs, and are often considered preventable. Effective skin care is paramount in preventing pressure ulcers, and clinical audit tools play a crucial role in ensuring best practices are implemented and consistently followed. This article provides a comprehensive set of clinical audit tool templates designed to enhance skin care and prevent pressure ulcers within hospitals and healthcare facilities. These tools are adapted from resources developed by leading healthcare research teams and quality improvement initiatives, offering a structured approach to assess readiness, implement best practices, and sustain improvements in pressure ulcer prevention.
Tool 0A: Introductory Executive Summary for Stakeholders
Purpose: This template serves as a foundational communication tool, designed as a letter to introduce key stakeholders within a hospital to a new pressure ulcer prevention project. It effectively communicates the project’s goals and underscores its importance to gain initial support.
Instructions: Customize this letter to align with your project specifics and present it to key individuals and departments. Utilize Tool 1B, Stakeholder Analysis, to pinpoint individuals and departments that should be involved and informed about the project.
Template Letter:
Dear [Name],
We are excited to introduce a vital new initiative focused on pressure ulcer prevention for our acute care patients. We are seeking your support for this important project.
Project Overview: [Hospital Name] is committed to enhancing patient care through a focused initiative on preventing pressure ulcers among acute care patients.
Significance: Pressure ulcers acquired during hospital stays significantly impede patient recovery, extend hospital stays, increase healthcare costs, and are classified as a “never event” by Medicare, impacting reimbursement.
Impact on Your Area: Pressure ulcer prevention is not solely a nursing responsibility. Successful reduction requires a multidisciplinary approach. This initiative may involve collaboration and adjustments across various departments:
- Materials and Supplies: Ensuring access to evidence-based products and equipment for pressure and skin breakdown prevention and evaluating new products with prevention in mind.
- Housekeeping: Reviewing bed-making techniques and materials to minimize moisture retention against patient skin.
- Information Technology: Integrating skin assessment and pressure ulcer prevention interventions into the electronic medical record (EMR) for efficient data management and accessibility.
- Respiratory Therapy: Ensuring proper placement of respiratory equipment to avoid pressure sores from tubing or mouthpieces.
- Medicine: Establishing protocols for ordering necessary support surfaces and preventive measures.
- Quality Improvement: Utilizing QI training and techniques to support the project team.
- Transport: Minimizing patient time on hard surfaces like wheelchairs or stretchers during transport for diagnostic or therapeutic procedures.
Project Implementation: We will implement the Agency for Healthcare Research and Quality’s (AHRQ) comprehensive toolkit. This toolkit provides step-by-step guidance and tools to assess staff knowledge, analyze patient care processes, and implement targeted interventions. We will also track and report pressure ulcer incidence to monitor progress and ensure accountability.
Call to Action: The success of this project hinges on a fundamental shift in perspective – from viewing pressure ulcers as unavoidable to recognizing them as preventable “never events.” Your support in fostering this cultural change is crucial. Thank you for your anticipated cooperation.
Tool 1A: Clinical Staff Attitudes Toward Pressure Ulcer Prevention
Purpose: The Staff Attitude Scale is designed to gather feedback on clinical staff beliefs and attitudes regarding pressure ulcer prevention. Understanding these attitudes is crucial for tailoring training and intervention strategies.
Reference: Adapted from a scale by Moore and Price (J Clin Nurs 2004;13:942-52).
Instructions: Administer this survey to all staff involved in direct patient care, typically anonymously. Scoring involves assigning values to responses (Strongly Disagree = 5, Strongly Agree = 1, with reverse scoring for questions 1, 6, 7, and 11). Scores range from 11 (most negative attitudes) to 55 (most positive attitudes).
Usage: Analyze survey results to identify prevailing attitudes and potential inconsistencies among different staff groups. Scores below 40 may indicate a need to address misperceptions and enhance training.
Views on Pressure Ulcer Prevention Survey
Your Role: _____________________ Date:___________________
| Strongly agree | Agree | Neither agree nor disagree | Disagree | Strongly disagree | |
|---|---|---|---|---|---|
| 1. All patients are at potential risk of developing pressure ulcers | |||||
| 2. Pressure ulcer prevention is time consuming for me to carry out | |||||
| 3. In my opinion, patients tend not to get as many pressure ulcers nowadays | |||||
| 4. I do not need to concern myself with pressure ulcer prevention in my practice | |||||
| 5. Pressure ulcer treatment is a greater priority than pressure ulcer prevention | |||||
| 6. Continuous assessment of patients will give an accurate account of their pressure ulcer risk | |||||
| 7. Most pressure ulcers can be avoided | |||||
| 8. I am less interested in pressure ulcer prevention than other aspects of care | |||||
| 9. My clinical judgment is better than any pressure ulcer risk assessment tool available to me | |||||
| 10. In comparison with other areas of care, pressure ulcer prevention is a low priority for me | |||||
| 11. Pressure ulcer risk assessment should be regularly carried out on all patients during their stay in hospital |
Tool 1B: Stakeholder Analysis
Purpose: This tool facilitates the identification of key departments and individuals who have a stake in the pressure ulcer prevention project. It helps in understanding potential barriers and planning actions to ensure stakeholder buy-in and active participation.
Reference: Adapted from Project Agency, UK.
Instructions: Complete the form to detail each key stakeholder’s interest, project needs from them, perceived attitudes, risks, and necessary actions to engage them effectively.
Usage: Use the completed analysis to develop strategies for stakeholder engagement and address potential roadblocks before project implementation.
| Stakeholder | Interest or requirement in the project | What the project needs from stakeholder
