The Impact of Education and Feedback on the Accuracy of Pressure Injury Staging and Documentation by Bedside Nurses

Abstract

Background: Pressure Injuries (PIs) are largely preventable. Accurate documentation of PI stage or progression is a key quality measure. Local Problem: Nurses frequently fail to accurately assess and document their findings in the electronic medical record. This project sought to increase nurses’ knowledge and accuracy of staging and documentation of PIs. Method: Educational interventions; direct observation of PI status; review of nurse documentation; feedback; and referrals to wound, ostomy, and continence nurses (WOCNs). Interventions: Nurses completed a pre- and post-test and online training modules, and participated in training sessions. Clinical experts completed direct skin observations and provided feedback about PI staging. Results: There was a statistically significant improvement in nurses’ knowledge about PIs (p = 0.004). Skin assessments were conducted on 108 patients (13 PIs identified). The bedside nurse accurately assessed a PI stage in only 31% of these observations. Referrals to WOCNs increased by 18% compared to the baseline period. Conclusions: Educational interventions enhanced nurses’ knowledge; however, appropriate PI staging may require skills development and validation to build competency.

Keywords

• pressure injury
• pressure ulcer
• wound care
• prevention
• evidence-based practice
• prevalence