1. Dillard, Cindy MSN, ARNP, NP-BC
  2. Skaggs, Pamela BSN, RN, CWOCN

Article Content


An interdisciplinary team developed a performance improvement project to increase nursing knowledge, interventions, and documentation of patients at risk for heel ulcer development.



An increase in pressure ulcer prevalence has been documented during national surveys.



The increased prevalence combined with changes in CMS reimbursement related to pressure ulcers in October 1, 2008, has prompted hospitals to improve methods for assessment, documentation, and prevention of pressure ulcers. Pressure ulcer development is also a nursing sensitive outcome and indicator of clinical quality. Patients in vascular and orthopedic populations are particularly at risk for heel ulcer development.



A plan was devised to assess, educate, evaluate, and reassess current nursing practices within the orthopedic and vascular population. A pretest was used to determine the staff nurse's level of knowledge on heel ulcer prevention. An audit was then performed to determine the level of compliance in regard to assessment, completion of the Braden scale, identification of patients at risk, intervention initiated, and documentation of intervention. An educational series for licensed and nonlicensed personnel was conducted addressing pressure redistribution devices, critical thinking checklist for heel ulcers, heel ulcer assessment/intervention tool, review of the Braden scale, and expectations for documentation. Upon completion, a posttest and 3-week chart audit was conducted to determine the impact on nursing practice, intervention, and documentation.



Two improvements were noted: nursing awareness of patients at risk for heel ulcers (76% vs 79%) and completion of the Braden score (88% vs 93%). However, there was no improvement in appropriate nursing intervention (26% vs 18%) or documentation of pressure ulcer prevention interventions (26% vs 18%).



Results showed that a one-time educational program did improve awareness of heel ulcer prevention but was not effective alone for nursing practice change.


Implications for Practice:

Further evaluation is required to determine the barriers that may exist. Introduction of cyclical education, visual cues, and education of nonlicensed personnel may add benefit and help to promote compliance with heel ulcer prevention strategies. Improvement of documentation may be augmented by automatic prompts in the electronic medical record.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.