Prevention and treatment of pressure ulcers: Clinical ... · PDF file1 National Pressure Ulcer...

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National Pressure Ulcer Advisory Panel

Registered Nurse Competency-based Curriculum: Pressure Ulcer Prevention

Barbara Pieper, PhD, RN, CWOCN, ACNS-BC, FAAN

Based on: National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure

ulcers: Clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009.

May 29, 2013

Major

Competencies/Objectives

Examples: Content

Objective(s)

Examples: Content Topic Examples: Teaching

Method

Possible references in

addition to the NPUAP

/EPUAP Prevention and

treatment of pressure

ulcers: Clinical practice

guideline, 2009. Many of

the references match more

than one objective, but are

listed in this document

one time only.

Understands pressure ulcer

incidence and prevalence

Define pressure ulcer

incidence and prevalence.

Participates in data

collection for pressure ulcer

incidence and prevalence.

Prevalence definition and

formula

Incidence definition and

formula

Lecture

Practice with data

collected within the

institution or developed

for practice.

Set up an agency program

to measure pressure ulcer

incidence and prevalence

Case studies

Discussion/analysis of

Dealey C, Chambers T,

Beldon P, Benbow M,

Fletcher J, Fumarola S,

Guy H, Nixon J, Price J,

Purser K, Stubbs N, Way

L, Weafer K; Members of

TVS Pressure Ulcer

Working Group.

Achieving consensus in

pressure ulcer reporting. J

http://www.ncbi.nlm.nih.gov.proxy.lib.wayne.edu/pubmed/22704905


2

articles about incidence

and prevalence.

Discussion/analysis of the

agency’s pressure ulcer

prevalence and incidence.

Develop methods to

decrease pressure ulcer

incidence.

Test: multiple choice,

true/false, etc.

Develop research/data

collection method for

institutional pressure ulcer

prevalence and incidence

studies

Tissue Viability.

2012;21(3):72-83.

He J, Staggs VS,

Bergquist-Beringer S,

Dunton N. Unit-level time

trends and seasonality in

the rate of hospital-

acquired pressure ulcers

in US acute care hospitals.

Res Nurs Health.

2013;36(2):171-80.

Hendrichova I, Castelli

M, Mastroianni C,

Piredda M, Mirabella F,

Surdo L, De Marinis MG,

Heath T, Casale G.

Pressure ulcers in cancer

palliative care patients.

Palliat Med.

2010;24(7):669-73.

Kottner J, Wilborn D,

Dassen T. Frequency of

pressure ulcers in the

paediatric population: a

literature review and new

empirical data. Int J Nurs

Stud. 2010;47(10):1330-













3

40.

Berlowitz D. Prevalence,

incidence, and facility

acquired rates. In Pieper

B. (Ed.) with the National

Pressure Ulcer Advisory

Panel (NPUAP). (2012).

Pressure ulcers:

Prevalence, incidence,

and implications for the

future. Washington, DC:

NPUAP, p 19-24.

Identify etiologic factors

contributing to pressure

ulcer occurrence.

Identify risk factors for

pressure ulcer

development.

Impaired mobility

Impaired activity

Nutritional indicators (

Common geriatric

syndromes impacted by

primary and secondary

nutrition preventions

Characteristics of

undernutrition and

malnutrition, Signs of

vitamin and mineral

deficiencies)

Factors affecting

perfusion and

oxygenation (diabetes;

cardiovascular

instability/norepinephrine

use; low blood pressure;

Lecture

Registered dietitian as

guest lecturer

Independent learning

modules

Case studies

Develop games based on

content

Poster with risk factors

Internet-based educational

programs

Simulation laboratory

patient practice

Patient-centered rounds on

unit

Institution –based

discussion on pressure

ulcer risk factors

Benoit R, Mion L. Risk

factors for pressure ulcer

development in critically

Ill patients: a conceptual

model to guide research.

Res Nurs Health.

2012;35(4):340-62.

White, J. Consensus

Statement: AND and

ASPEN: characteristics

recommended for the

identification and

documentation of adult

malnutrition

(undernutrition.) J Acad

Nutr Diet 2012, 112.5.






4

ankle brachial index;

oxygen use; smoking)

Skin moisture

Advanced age

Shear

Sensory perception

General health status

Persons of color: race

and ethnicity


true/false, etc.

730-738.

Törmä J, Winblad U, Cederholm T, et al. Does undernutrition still prevail among nursing home residents? Clin Nutr. 2013 Aug; 32(4):562-8.

Kane RL, Talley KM, Shamliyan T. et al. Common Syndromes in Older Adults Related to Primary and Secondary Prevention. Evidence Report/Technology Assessment No. 87. AHRQ Publication No. 11-05157-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; July 2011.

Bernabe KQ. Pressure

ulcers in the pediatric

patient. Curr Opin

Pediatr. 2012;24(3):352-

6.




5

Black JM, Edsberg LE,

Baharestani MM,

Langemo D, Goldberg M,

McNichol L, Cuddigan J;

National Pressure Ulcer

Advisory Panel. Pressure

ulcers: avoidable or

unavoidable? Results of

the National Pressure

Ulcer Advisory Panel

Consensus Conference.

Ostomy Wound Manage.

2011;57(2):24-37.

Black J, Baharestani M,

Black S, Cavazos J,

Conner-Kerr T, Edsberg

L, Peirce B, Rivera E,

Schultz G. An overview

of tissue types in pressure

ulcers: a consensus panel

recommendation. Ostomy

Wound Manage.

2010;56(4):28-44.

Cakmak SK, Gul U, et al.

Risk factors for pressure

ulcers. Adv Skin Wound

Care. 2009;22;412-415.

Doughty D, Junkin J,











6

Kurz P, Selekof J, Gray

M, Fader M, Bliss DZ,

Beeckman D, Logan S.

Incontinence-associated

dermatitis: consensus

statements, evidence-

based guidelines for

prevention and treatment,

and current challenges. J

Wound Ostomy

Continence Nurs.

2012;39(3):303-15; quiz

316-7.

Fogerty MD, Guy J, et al.

African Americans show

increased risk for pressure

ulcers: a retrospective

analysis of acute care

hospitals in America.

Wound Rep Reg.

2009;17:678-684.

Guihan M, Bombardier

CH. Potentially

modifiable risk factors

among veterans with

spinal cord injury

hospitalized for severe

pressure ulcers: a

descriptive study. J Spinal














7

Cord Med.

2012;35(4):240-50.

Hanson D, Langemo DK,

Anderson J, Thompson P,

Hunter S. Friction and

shear considerations in

pressure ulcer

development. Adv Skin

Wound Care.

2010;23(1):21-4.

Masotti P, McColl MA,

Green M. Adverse events

experienced by homecare

patients: a scoping review

of the literature. Int J

Qual Health Care.

2010;22(2):115-25.

Sieggreen M. Pressure

ulcers in persons of color:

race and ethnicity. In

Pieper B. (Ed.) with the


Advisory Panel (NPUAP).

(2012). Pressure ulcers:




NPUAP, p 147-150.









8

VanGilder C, Amlung S,

et al. Results of the 2008-

2009 international

pressure ulcer prevalence

survey and a 3-year, acute

care, unit-specific

analysis. Ostomy Wound

Manage. 2009;55:39-45.

Wound Ostomy and

Continence Nurses

Society. Guideline for

prevention and treatment

of pressure ulcers. Mount

Laurel, NJ, 2010.

Conduct a structured risk

assessment on admission,

and repeat as regularly and

as frequently as required

by patient acuity and

setting.

Select a risk assessment

method or tool appropriate

to the population

(e.g., Braden Scale, Braden

Q, & Norton Scale).

Use a structured approach

to risk assessment to

identify individuals at risk

of developing pressure

ulcers.

Calculate an individual’s

pressure ulcer risk

assessment score.

Interpret the significance of

the pressure ulcer risk

Braden Scale

Braden Q Scale

Norton Scale

Lecture


modules

Case studies

DVD showing patient to

rate for pressure ulcer risk.

Discussion of difficulties

in using a risk assessment

tool.

Develop decision tree on

how to respond to risk

assessment tool’s findings

Poster showing risk

assessment tool

Observation and

Baharestani MM, Ratliff

CR. Pressure ulcers in

neonates and children: an

NPUAP White Paper. Adv

Skin Wound Care.

2007;20:2008-220.

Bergquist-Beringer S,

Daley CM. Adapting

pressure ulcer prevention

for use in home health

care. J Wound Ostomy

Continence Nurs.

2011;38(2):145-54.





9

score.

Use professional judgment

in evaluating risk

assessment scores and

individual risk factors in

the context of the

individual’s goals and

needs.

Reassess pressure ulcer risk

as significant changes

occur in a patient’s health

status.

evaluation of clinical use

of risk assessment tool.


experience with risk

assessment.

Bolton L. Which pressure

ulcer risk assessment

scales are valid for use in

clinical settings. J Wound

Ostomy Continence Nurs.

2007;34:368-381.

Denby A, Rowlands A.

Stop them at the door –

should a pressure ulcer

prevention protocol be

implemented in the

emergency department. J

Wound Ostomy

Continence Nurs.

2010;37:35-38.

Gadd MM. Preventing

hospital-acquired pressure

ulcers: improving quality

of outcomes by placing

emphasis on the Braden

subscale scores. J Wound


2012;39(3):292-4.

Niederhauser A,

VanDeusen Lukas C,

Parker V, Ayello EA,

Zulkowski K, Berlowitz

D. Comprehensive








10

programs for preventing

pressure ulcers: a review

of the literature. Adv Skin

Wound Care.

2012;25(4):167-88; quiz

189-90.

Ensure that a complete

skin assessment is part of

the risk assessment

screening policy in place

in all health care settings.

Conduct a thorough skin

assessment.

Assess skin on admission

and routinely thereafter.

Inspect skin at bony

prominences and other

areas of exposure to

etiologic factors.

Able to identify blanching

response, localized heat,

edema, and induration.

Identify issues in the skin

assessment of individuals

with darkly pigmented

skin.

Ask individuals to identify

areas of discomfort or pain

that could be attributed to

pressure ulcer damage.

Observe skin for pressure

damage by mechanical

devices.

Know pressure ulcer

stages: Stages I – IV,

unstageable, suspected

Body areas critical for

assessment

Blanching

Edema

Induration

Color and darkly

pigmented skin

Pain tools

Pressure ulcer stages

Documentation of skin

and pressure ulcers

Lecture


modules

Pictures showing pressure

changes on light and

darkly pigmented skin.

DVD of risk assessment

Clinical practice

Pictures showing pressure

damage from mechanical

devices

Role play skin assessment

and documentation


true/false, etc.

Black J, Baharestani M, et

al. An overview of tissue

types in pressure ulcers: a

consensus panel

recommendation. Ostomy

Wound Manage.

2010;56:28-44.

Black J, Langemo D.

Pressure ulcer

staging/categorization. In








NPUAP, p. 5-14.

Gorecki C, Closs SJ,

Nixon J, Briggs M.

Patient-reported pressure

ulcer pain: a mixed-

methods systematic







11

deep tissue injury.

Document all skin

assessment.

review. J Pain Symptom

Manage. 2011;42(3):443-

59.

Patton RM. Is diagnosis

of pressure ulcers within

an RN’s scope of

practice? Am Nurse

Today. 2010;5:20.

Develop and implement an

individualized program of

skin care.

Discuss “do not turn” the

individual onto a body

surface that is still

reddened from a previous

episode of pressure

loading.

Discuss “do not use

massage” for pressure ulcer

prevention.

Discuss “do not vigorously

rub” skin that is at risk for

pressure ulceration.

Use skin emollients to

hydrate dry skin in order to

reduce risk of skin damage.

Identify individualized

schedule of skin cleansing.

Identify protection of the

skin from exposure to

excessive moisture with a

barrier product to reduce

the risk of pressure

Repositioning/turning

Massage

Skin emollients

Barrier products

Incontinence care

protocols

End of life care

Skin care for the patient

with obesity

Skin care for the

child/neonate

Skin care for patient in

long term care,

rehabilitation, and/or

home.

Lecture


modules

Internet-based educational

modules

DVD/video showing skin

care

Observation and

evaluation of clinical

practice within a

facility/unit.

Evaluation of medical

record notations (paper

and electronic).

Product posters, forms,

demonstrations, etc. of

available skin care

products in the institution

Decision tree tools as to

skin hydration and damage

and products to use.

Teaching materials about a

Baharestani MM. Pressure

ulcers in pediatric

populations. In Pieper B.

(Ed.) with the National



Pressure ulcers:




NPUAP, p.151-172.

Ganos D, Siddiqui A.

Operating room. In Pieper

B. (Ed.) with the National



Pressure ulcers:




NPUAP, p. 57-64.


12

damage.

For the individual with

incontinence, consider

frequency and methods of

cleaning, skin protection

(barriers, products), and

management

strategies/evaluation for

incontinence.

Consider end of life care as

it affects the skin care

protocol.

Consider the plan of care

for the patient with

excessive weight

(bariatric).

Consider plan of care for

the neonate and child.


for the patient undergoing

surgery.


for the patient in long term

care, rehabilitation

facilities, and home care.

skin care program for

patients/ families

Develop/use transfer form

with skin assessment and

care to home, long term

care, rehabilitation, etc.

Mentoring novice nurse

Develop research about


programs

Garcia AD. Home care. In








NPUAP, p. 97-104.

Langemo D. General

principles and approaches

to wound prevention and

care at end of life: an

overview. Ostomy Wound

Manage. 2012;58(5):24-6,

28, 30 passim.

Langemo DK, Black J;


Advisory Panel. Pressure

ulcers in individuals

receiving palliative care: a


Advisory Panel white

paper. Adv Skin Wound

Care. 2010;23(2):59-72.

Levine SM, Sinno S,

Levine JP, Saadeh PB.












13

Current thoughts for the

prevention and treatment

of pressure ulcers: using

the evidence to determine

fact or fiction. Ann Surg.

2013;257(4):603-8.

McCaskey MS, Kirk L,

Gerdes C. Preventing skin

breakdown in the

immobile child in the

home care setting. Home

Healthc Nurse.

2011;29(4):248-55; quiz

256-7.

Nenna M. Pressure ulcers

at end of life: an overview

for home care and hospice

clinicians. Home Healthc

Nurse. 2011;29(6):350-

65; quiz 366-7.

Pieper B. Long term

care/nursing home. In




















14


NPUAP, p. 65-88.

Pieper B. Rehabilitation

facilities. In Pieper B.




Pressure ulcers:




NPUAP, p. 89-96.

Schubart J. An e-learning

program to prevent

pressure ulcers in adults

with spinal cord injury: a

pre- and post- pilot test

among rehabilitation

patients following

discharge to home.


2012;58(10):38-49.

Sibbald RG, Krasner DL,

et al. SCALE: skin

changes at life’s end: final

consensus statement:

October 1, 2009. Adv Skin

Wound Care.









15

2010;23:225-235.

Sieggreen M. Pressure

ulcers in morbidly obese

patients. In Pieper B.




Pressure ulcers:




NPUAP, p. 147-150.

White-Chu EF, Flock P,

Struck B, Aronson L.

Pressure ulcers in long-

term care. Clin Geriatr

Med. 2011;27(2):241-58.

Demonstrate proper

positioning/repositioning

for pressure ulcer

prevention/treatment.

Consider the use of

repositioning in all at-risk

individuals.

Understand repositioning

frequency will be

determined by the

individual’s tissue

tolerance, level of activity

and mobility, general

medical condition, overall

treatment objectives, and

assessment of the skin.

Repositioning techniques

and schedules

Positioning techniques

and timing

Documentation

Lecture


modules

DVD/video showing

positioning/repositioning

Practice in a simulation

laboratory proper

positioning

Demonstration/return

demonstration of

positioning techniques by

physical therapists

Burk RS, Grap MJ.

Backrest position in

prevention of pressure

ulcers and ventilator-

associated pneumonia:

conflicting

recommendations. Heart

Lung. 2012;41(6):536-45.

Lyder CH. Preventing

heel pressure ulcers:

economic and legal












16

Practice proper positioning

to off set load (e.g. sitting,

lying, height of bed).

Use transfer aids to reduce

friction and shear.

Understand and

demonstrate repositioning

should be undertaken using

the 30-degree tilted side-

lying position, back, and

prone as tolerated.

Know to avoid, if possible,

head-of-the bed elevation

and a slouched position that

places pressure and shear

on the sacrum and coccyx.

Understand the limit the

time an individual spends

seated in a chair without

pressure relief.

Demonstrate appropriate

recording of repositioning

regimes.

Observation and

evaluation of clinical

practice

Evaluation of medical

record notations



repositioning products

available in the institution

Teaching materials about

repositioning for

patients/families


true/false, etc.

Develop research about


techniques and/or

treatment

implications. Nurs

Manage. 2011;42(11):16-

9.

Moore ZE, Cowman S.

Repositioning for treating

pressure ulcers. Cochrane

Database Syst Rev. 2012

Sep 12;9:CD006898.

Salcido R, Lee A, Ahn C.

Heel pressure ulcers:

purple heel and deep

tissue injury. Adv Skin

Wound Care.

2011;24(8):374-80; quiz

381-2.

Still MD, Cross LC,

Dunlap M, Rencher R,

Larkins ER, Carpenter

DL, Buchman TG,

Coopersmith CM. The

turn team: a novel strategy

for reducing pressure

ulcers in the surgical

intensive care unit. J Am

Coll Surg.

2013;216(3):373-9.

Wanless S, Aldridge M.












17

Continuous lateral

rotation therapy - a

review. Nurs Crit Care.

2012;17(1):28-35.

Choose appropriate

support surface for a

patient based on risk and

the patient’s attributes.

Select support surfaces

based on level of pressure

ulcer risk, pressure ulcer

stage, level of mobility,

comfort, and place and

circumstances of care

provision.

Know uses/attributes of

various support surfaces.

Demonstrate protection of

heels with elevation of the

heels off the surface.

Understand use of support

surfaces to prevent pressure

ulcers while seated.

Understand to avoid use of

synthetic sheepskin pads;

cutout, ring, or donut-type

devices; and water filled

gloves.

Consider use of pressure

redistribution products in

the operating room.

Understand safe application

and maintenance of support

surfaces.

Support surfaces for bed

and chair

Heel elevation and

products

Support surfaces in

multiple inpatient

departments such as

emergency and operating

room.

Lecture

DVD/video showing

support surface types,

attributes, uses, etc.

Include

physical/occupational

therapist in teaching

content



support surfaces available

in the institution

Decision tree tool as to

how to select a support

surface

Teaching materials about

support surfaces for

patients/families

Include representatives

from Emergency

Department and Operating

Room in selection of

pressure redistribution

surfaces.


true/false, etc.

Mentoring novice nurse

Junkin J, Gray M. Are

pressure redistribution

surfaces or heel protection

devices effective for

preventing heel pressure

ulcers? J Wound Ostomy

Continence Nurs.

2009;36:602-608.

Lyman V. Successful heel


program in a long-term

care setting. J Wound


2009;36:616-621.

McInnes E, Jammali-Blasi

A, Bell-Syer S, Dumville

J, Cullum N. Preventing

pressure ulcers--Are

pressure-redistributing

support surfaces

effective? A Cochrane

systematic review and

meta-analysis. Int J Nurs

Stud. 2012;49(3):345-59.











18

Develop research

study/quality assurance

study about support

surfaces for the agency

McGinnis E, Stubbs N.

Pressure-relieving devices

for treating heel pressure

ulcers. Cochrane


Sep 7;(9):CD005485.

McInnes E, Dumville JC,

Jammali-Blasi A, Bell-

Syer SE. Support surfaces

for treating pressure

ulcers. Cochrane


Dec 7;(12):CD009490.

McInnes E, Jammali-Blasi

A, Bell-Syer SE,

Dumville JC, Cullum N.

Support surfaces for

pressure ulcer prevention.

Cochrane Database Syst

Rev. 2011 Apr

13;(4):CD001735.

Morton N. Preventing and

managing heel pressure

ulceration: an overview.

Br J Community Nurs.

2012;Suppl:S18, S20-2

Pham B, Teague L,












19

Mahoney J, Goodman L,

Paulden M, Poss J, Li J,

Sikich NJ, Lourenco R,

Ieraci L, Carcone S,

Krahn M. Support

surfaces for intraoperative

prevention of pressure

ulcers in patients

undergoing surgery: a

cost-effectiveness

analysis. Surgery.

2011;150(1):122-32.

Shoham N, Gefen A.

Deformations, mechanical

strains and stresses across

the different hierarchical

scales in weight-bearing

soft tissues. J Tissue

Viability. 2012;21(2):39-

46.

Sprigle S, Sonenblum S.

Assessing evidence

supporting redistribution

of pressure for pressure

ulcer prevention: a

review. J Rehabil Res

Dev. 2011;48(3):203-13.

Turnage-Carrier C,


















20

McLane KM et al.

Interface pressure

comparison of healthy

premature infants with

various neonatal bed

surfaces. Adv Neonatal

Care. 2008;8:176-184.

VanGilder C,

Lachenbruch CA. Air-

fluidized therapy: physical

properties and clinical

uses. Ann Plast Surg.

2010;65(3):364-70.

Implement nutritional

interventions as

appropriate to prevent

pressure ulcers.

Using a valid/reliable tool,

screen the nutritional status

of every individual at risk

of pressure ulcers.

Refer individuals with

nutritional risk to a

registered dietitian and/or

nutritional team for a

comprehensive nutrition

assessment.

Describe the importance of

nutrition, hydration,

vitamins and minerals.

Describe the role of

inflammation as a

contributor to declining

Nutrition screening using

a validated tool to

determine under-nutrition

and/or malnutrition

Factors to consider when

implementing a nutrition

plan designed by the

registered

dietitian/nutrition team

which may include

supplementation

(calories, protein, fluids,

vitamins, minerals per

registered dietitian’s

assessment), mor

frequent meals or

Lectures include dietitian

Validated nutrition

screening tools such as

Mini-Nutritional

Assessment (MNA) Short

Form, Malnutrition

Universal Screening Tool,

Short Nutritional

Assessment Questionnaire

Nutrient fact sheets

Decision tree as to when to

consult dietitian

Case studies

Develop games based on

nutrition information

Pictures/posters showing

Cereda E, Klersy C,

Rondanelli M,

Caccialanza R. Energy

balance in patients with

pressure ulcers: a

systematic review and

meta-analysis of

observational studies. J

Am Diet Assoc.

2011;111(12):1868-76.

Collins N. Nutrition

PEARLS: the latest

nutrition hot topics.


2010;56:14-18.











21

nutritional status

Describe the rationale for

ordering oral nutrition

supplements, protein

supplements or other food

fortifiers

Describe feeding methods

(i.e., oral, enteral,

parenteral)

Recognize the clinical signs

of under-nutrition (e.g.,

unintended weight loss,

physical signs, laboratory

data etc.).

State the goals of nutrition

therapy for an individual.

nutrient dense snackls

between meals.

Feeding strategies.

Nutrition-related

laboratory values

Referral criteria to

registered dietitian,

speech language

pathologist, and/or

occupational therapist.

clinical signs/symptoms of

nutritional deficiencies

Internet-based programs

on nutrition.


experiences with nutrition

assessment.

Discussion of laboratory

and other data in terms of

nutrition assessment and

inflammatory stress.

Teaching materials for the

patient/family in terms of

nutrition for prevention

and treatment of pressure

ulcers.


true/false, etc.

Dorner B, Posthauer ME, et

al. The role of nutrition in


and treatment: National


Panel white paper. Adv Skin

Wound Care. 2009;22:212-

221.

Jensen GL , Mirtallo J ,

Compher C , et al. Adult

starvation and disease-

related malnutrition: A

rational approach for

etiology-based diagnosis in

the clinical practice setting

from the International

Consensus Guideline

Committee . JPEN 2010,

34.2. 156–159.

Friedman,A, Fadem, S. Reassessment of Albumin as a Nutritional Marker in Kidney Disease. J Am Soc Nephrol 21: 223–230, 2010

Johnson , AM, Merlini,G. Clinical indications for plasma protein assays: transthyretin (prealbumin) in

22

inflammation and malnutrition. Clin Chem Lab Med 2007;45(3):419-426

Litchford, MD, Dorner, B,

Posthauer, ME.

Malnutrition as a

precursor of pressure

ulcers. Advances in

Wound Care, in press.

Little MO. Nutrition and

skin ulcers. Curr Opin

Clin Nutr Metab Care.

2013;16(1):39-49.

Accurately document

results of risk assessment,

skin assessment, and

prevention

strategies.

Know documentation

needed for risk assessment,

skin assessment,

interventions, and

prevention strategies.

Interprets/records the

individual’s response to

interventions.

Practices the agency’s

frequency/method of

documentation including

initial and periodic

reevaluation.

Documentation

Lecture

Guest speakers: attorney;

insurance regulator

Practice with risk

assessment tool and

recording findings

Mock/practice charting

sessions

Electronic medical record

Case reports

Peer review of charting

Mentoring of novice

nurses

Ayello EA, Capitulo KL,

et al. Legal issues in the

care of pressure ulcer

patients: key concepts for

healthcare providers. A

consensus paper from the

International Expert

Wound Care Advisory

Panel. J WCETN.

2009;29:8-22.

Farren M, Martelly-

Kebreau Y. OASIS-C

importance of accurate





23

pressure ulcer assessment

and management in home

healthcare: part II. Home

Healthc Nurse.

2011;29(10):599-609.

O'Meara SM, Bland JM,

Dumville JC, Cullum NA.

A systematic review of

the performance of

instruments designed to

measure the dimensions

of pressure ulcers. Wound

Repair Regen.

2012;20(3):263-76.

Wound Ostomy and

Continence Society

Position Paper. Avoidable

versus unavoidable

pressure ulcers. J Wound


2009;36:378-381.

Apply critical thinking

skills to clinical decision

making regarding the

impact of changes in the

individual’s condition on

pressure ulcer risk.

Demonstrate critical

thinking in pressure ulcer

risk assessment.

Demonstrates critical

thinking by accurately

interpreting changes in

patient’s status and its

influence on plan of care to

Critical thinking Case studies to

demonstrate mastery of

content about pressure

ulcer risk, change in

patient’s status, etc.

Peer review of practice

and charting

Journal club critical









24

prevent pressure ulcers.

Identification of patient

triggers that require

changes in plan of care.

review of publication

Peer coaching/mentoring

Ethics and pressure ulcers

Make referrals to other

health care professionals

based on client

assessment.

Knows role of health team

members in pressure ulcer

prevention/treatment.

Knows how to initiate

home care referral

properly.

Role of nurse, physician,

dietitian, physical

therapist, etc. in pressure

ulcer prevention

Lecture

Panel discussion presented

by various pressure ulcer

prevention/treatment team

members

Interdisciplinary patient

rounds on patients at risk

for pressure ulcers or who

have pressure ulcers

Interagency discussions on

the best procedures to

facilitate patient transfer.

Peer coaching/mentoring

Butler M, Collins R,

Drennan J, Halligan P,

O'Mathúna DP, Schultz

TJ, Sheridan A, Vilis E.

Hospital nurse staffing

models and patient and

staff-related outcomes.

Cochrane Database Syst

Rev. 2011

6;(7):CD007019.

Choi J, Bergquist-

Beringer S, Staggs VS.

Linking RN workgroup

job satisfaction to

pressure ulcers among

older adults on acute care

hospital units. Res Nurs

Health. 2013;36(2):181-

90

Soban LM, Hempel S,

Munjas BA, Miles J,

Rubenstein LV.

Preventing pressure ulcers

in hospitals: A systematic

review of nurse-focused












25

quality improvement

interventions. Jt Comm J

Qual Patient Saf.

2011;37(6):245-52.

Sullivan N, Schoelles

KM. Preventing in-facility

pressure ulcers as a

patient safety strategy: a

systematic review. Ann

Intern Med. 2013 5;158(5

Pt 2):410-6.

Walker Sewill DK, Van

Sell S, Kindred C.

Pressure ulcer prevention:

utilizing unlicensed

assistive personnel. Crit

Care Nurs Q.

2010;33(4):348-55.

Revision of the 2010 Registered Nurse Competency-based Curriculum: Pressure Ulcer Prevention










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