Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Elizabeth Ercolano

Abstract

Purpose: The purpose of this QI project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline for minor skin lesions.

Participants and Setting: This wound care guideline was developed for nurses working on inpatient adult acute care units. The setting was a large community hospital in southwest Minnesota.

Approach: The guideline was validated for its clarity and appropriateness by external and internal expert wound care nurses. It was implemented through in-person unit rounding on the nursing units, distribution of badge cards with the guideline, and a required online education module about the guideline. Surveys and audits were conducted to measure changes in knowledge and skin care pre- and post-guideline implementation.

Outcomes: Wound documentation audits assessing whether patients had an appropriate treatment improved from 45% (104 out of 231) to 80% (209 out of 260). Nurses’ self-rating of their knowledge about which dressings and topical treatment to use improved from 18% (16 out of 89) agreement to 57% (55 out of 96). Nurses’ self-rating of their knowledge about when to change dressings and reapply topical treatments improved from 27% (24 out of 89) agreement to 65% (62 out of 96).

Implications for Practice: Although there is evidence for a variety of dressings or products to treat wounds, this QI project demonstrated increased compliance with providing appropriate care when just a few treatment options were recommended to nursing staff through a structured guideline. This guideline continues to be used at the project site and is now being implemented at affiliate hospitals.

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