NAC input, simplified processes key to pressure ulcer prevention

Regency at Puyallup, WA Rehabilitation Center significantly reduced their high-risk pressure ulcer rates: from an average of 18.1 in 2003-2005 down to 5.2 for the second quarter of 2006.

How did they achieve such a substantial change? The Regency team approached this challenge from several angles, trying one method at a time and working out the kinks before instituting house-wide changes. Here’s a sampling of challenges that they identified, along with the steps they took to resolve them.

Complex, multi-page protocols

They updated and simplified the protocols. Whenever possible, they are now printed on a single page, in a chart or flow-sheet format.

Care plans not implemented promptly

Further simplifying their systems, the Regency team used the Braden Scale pressure ulcer risk categories to develop four corresponding “shopping list” care plans. These care plans serve as cues for busy nurses, are quick to initiate, and allow NACs to perform many of the prevention steps.

Failure to promptly identify changing risk factors

While the licensed nursing staff can readily identify a resident’s pressure ulcer risk level, the Regency team realized that NACs, who are in closer daily contact with the residents, were better positioned to identify subtle changes. They decided to train the NACs on the use and purpose of the Braden Scale.

The NACs are now better able to recognize and report changes, and care plans are initiated more quickly. Training the NACs about the Braden Scale “has been a tremendous help,” Lisa Briley, RN, said. “Instead of us telling the NACs to do something, they are letting us know that they’ve already done it.”