Pressure ulcer monitoring: a process of evidence-based practice, quality, and research

A number of settings in eastern Ontario, Canada, have collaborated on establishing a common pressure ulcer monitoring system. This work was undertaken in a proactive effort to implement practice guideline recommendations related to pressure ulcer prevention. The monitoring system was developed at The Ottawa Hospital (Ottawa, Ontario, Canada), an acute care teaching hospital, and then shared with multiple settings, which adopted it.

A work group was formed with clinical, quality, and research expertise. In a prospective (rather than retrospective) chart audit, 12-hour point prevalence surveys are conducted in which risk, occurrence, and interventions are tracked. Trained surveyors conduct a standard risk appraisal, head-to-toe skin assessment, and chart scan. Reporting mechanisms were developed at the organization, program, and unit levels.

Between 2001 and 2007, despite an inpatient population of which usually more than 25% were at "high" risk, prevalence decreased from 18% to 14%.

Fifteen years' experience in pressure ulcer monitoring suggests the following recommendations: (1) create and enable skin care champions to monitor and develop unit-based solutions in response to survey findings; (2) embed monitoring in the quality and professional practice infrastructure of the organization; (3) use existing structures and processes such as unit councils or quality committees; quality processes and practice panels are ideal venues to situate pressure ulcer monitoring at both organizational and unit levels; and (4) create a data collection process that is as clinically sensible and feasible as possible.

Monitoring is the linchpin that formed the foundation for the long-term, systemwide undertaking of the prevention of pressure ulcers and that created the climate for change and continued momentum.