Members of the RIH 5 North Pressure Ulcer Team: From left to right (back row) Akiko Grant, LPN; Hazel McKinney, PCC; Tanya Uyeda, RN; Naomi Erickson, QI Consultant; Adam Szpak, SWS; and left to right (front row) Candace Laughy, LPN; Natalee Brasseur, OT; Margarette Harris, Unit Clerk; Margaret Skookum, LPN

In recent years, studies have shown the prevalence and enormous cost of pressure ulcers to society, in terms of patient suffering, caregiver anguish, extra work for healthcare providers, and millions spent in healthcare dollars – all for a largely preventable condition.

To draw attention to the importance of pressure ulcer prevention, an innovative teaching approach is underway at Royal Inland Hospital (RIH). The initiative began two years ago as a pilot project on RIH 6 North and is growing into a cross-hospital educational model for all staff. They have begun to shift their pressure ulcer prevention efforts towards more of an interdisciplinary approach.

Using a real pressure ulcer case (de-identified to protect patient confidentiality) that was reported in the BC Patient Safety & Learning System (PSLS), the team has developed unique teaching tools that are touching the minds and hearts of many hospital staff.

“When we have the resources and equipment we need to prevent pressure ulcers from happening, that’s great,” says Naomi Erickson, Quality Improvement Consultant IH West, “but if we can show our staff something real and tangible, it really brings the message home.”

The key to pressure ulcer prevention is identifying patients who may be at risk. Some patients may show signs of a pressure ulcer upon admission to hospital, while other patients may develop a pressure ulcer during their stay. Naomi says that using an actual case to teach staff about pressure ulcer prevention by has been very well-received by the RIH team.

“We developed visual aids and a timeline of the progression of the patient’s pressure ulcer over time,” says Naomi. “During our education sessions, we discovered that all RIH staff – nurses, physicians, occupational therapists, and many others involved in patient care – found this approach extremely effective for learning how to prevent pressure ulcers.”  

“Using an interdisciplinary approach to pressure ulcer prevention allows us to have several members of the healthcare team speak up if they see a patient at risk,” says Naomi. “I’ve been very impressed with how receptive the RIH healthcare team has been to this initiative, and this has made pressure ulcer prevention a priority at RIH.”

Naomi says that in addition to increased awareness about pressure ulcer prevention, RIH is working hard to identify ways to increase their Braden Scale compliance. The Braden Scale is a pressure ulcer risk assessment tool completed by nursing on admission and periodically throughout a patient’s stay. There is a direct positive correlation to completion of the Braden Scale and prevention/intervention of pressure ulcers.

The RIH 5 North Pressure Ulcer Team, for example, recently achieved a 90% compliance rate with Braden Scales on admission and throughout the patient’s stay. “This team is working very hard at their pressure ulcer prevention work,” says Naomi.

When asked about the benefits of PSLS, Naomi says, “PSLS helps us to know whether a patient came to us with a pressure ulcer, or not. It gives us a way to track pressure ulcer issues, the outcome of treatment and, most importantly, share our learning with other RIH patient care teams.”

The RIH pressure ulcer teaching model will be shared across Interior Health (IH) over the coming months. In addition, improvements to PSLS over the coming weeks will support better data collection about pressure ulcer events to facilitate learning and improve patient safety.

Congratulations Naomi and RIH staff! Thank you for being proactive and protecting patients from pressure ulcers.

Additional resources:

• For more information about Braden Scales visit the Institute for Healthcare Improvement
• For more information about pressure ulcer awareness and prevention visit the Canadian Association of Wound Care