1. Hays, Victoria MN, CNS, APRN-BC

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To share successful strategies in the development of a pressure ulcer prevention and treatment program facilitated by a med/surg CNS.



The med/surg CNS at Providence Portland Medical Center, a Magnet facility, established a partnership with the WOCNs and nursing staff on 15 acute care units to reduce the hospital-acquired pressure ulcer rate from 20% to 3.8% in 36 months. As a result of this partnership, the stage 2 and greater PU rate has decreased from 9% to 1.9%.



This is a very important nursing quality indicator for hospitals and ties directly with the new Centers for Medicare and Medicaid Services no-pay measure for HA PUs. In addition, Providence believes in providing excellent, cost-effective care to every patient, and our mission is to do no harm to our patients.



Successful strategies by the CNS include soliciting executive and management support to ensure pressure ulcer prevention and treatment are a priority for the facility and resources are allocated annually for this initiative. Secondly, the CNS cofacilitates with the WOCNs a monthly Skin Care Resource Nurse meeting using evidenced-based practice to a group of over 30 nurses representing every acute care unit in the facility. Thirdly, under the supervision of the CNS, the WOCNs monitor 12 clinical units on a daily basis focused on prevention and treatment of stage 2 and greater PUs. Lastly, managing the specialty support surfaces is important in the prevention and treatment of PUs. A specialty support algorithm was created and developed by the CNS and WOCNs and implemented house-wide in 2007. As a result, 2 years later, a cost savings of over $40,000 has resulted and nursing is confident in ensuring patients are placed on the appropriate support surface and discontinued when criteria are no longer met by the patient.



A reduction in the hospital-acquired pressure ulcer (PU) rate from 20% to 3.8% in 36 months. In addition, the stage 2 and greater PU rate has decreased from 9% to 1.9%.



Within the past 3 years, the culture of Providence Portland Medical Center has drastically improved and staff has taken ownership of pressure ulcer rates and results on their units. Staff is deeply affected when even 1 patient develops a hospital-acquired pressure ulcer on their unit. It is because of this culture change at Providence that the facility will achieve 0% hospital-acquired pressure ulcer rate during 2009.


Implications for Practice:

By implementing these strategies, nursing facilities will be successful in their pressure ulcer prevention and treatment program.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those 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 for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.