1. Krupp, Anna MS, RN, CCRN, CCNS

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The purpose of this clinical project was to reduce hospital-acquired pressure ulcers (HAPUs) in our 24-bed medical/surgical/trauma ICU and maintain our monthly rate below the National Database of Nursing Quality Indicators benchmark.



Hospital-acquired pressure ulcers generate significant burdens. The literature shows that the average HAPU has an associated cost estimated at $43,000 per hospital stay. Recent financial implications for hospital-acquired conditions have made prevention even more imperative. Hospital-acquired pressure ulcers also have negative effects on patients' emotional, mental, physical, and social quality of life.



A review of pressure ulcer data identified gaps in practice, which led to development of staff education and an evidence-based pressure ulcer prevention protocol.



Planning and implementation were achieved through unit-based CNS collaboration with skin CNS, unit-based clinical nurse manager, patient care coordinator, medical director, and skin resource nurses. Our strategies for pressure ulcer reduction included the following: staff education focusing on risk assessment, documentation, and prevention; monthly review of data and implementation of changes based on pressure ulcer location trends, including changing medical device securement methods; routine dissemination of the data to staff; development and implementation of an evidence-based pressure ulcer prevention protocol; growth and development of a unit-based skin resource team which includes RNs and nursing assistants; and implementation of weekly CNS rounding on patients with Braden scores less than 12. Regular attention to HAPU continues to occur monthly with skin resource nurse meetings, discussion of HAPU data at unit interdisciplinary QI meetings, and dissemination of data to staff.



We reduced our unit HAPU rate by 46% and our monthly rate of HAPUs is now below or near National Database of Nursing Quality Indicators benchmark. A significant change in unit culture has been noted; pressure ulcers are preventable. Considerable improvements are also evidenced by improved skin assessments and prevention-focused interventions.



Multiple strategies and consistent attention to this quality indicator have decreased HAPU rates.


Implications for Practice:

Clinical nurse specialists play an integral role in development, implementation, and ongoing evaluation of the program. Continued development and support of a unit-based skin resource team are also essential in effecting change.


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.