Evidence-based best practice in maintaining skin integrity

The study reported here describes a 1 year programme to promote best practice in maintaining skin integrity, ensuring consistent clinical practices in relation to skin care, and managing skin breakdown. The analysis included baseline data on skin breakdown; comparisons of policy and practice with clinical guidelines and best practice locally, interstate and internationally; a quality improvement trial focusing on mobility, skin condition, diet and hydration, hygiene and elimination; and implementation of best practice, including analysis of the relative quality and clinical outcomes of products, practices and documentation strategies. Product evaluation by nurses and patients showed that all mattresses trialled were effective in minimising or preventing skin breakdown. All chair cushions were rated effective in preventing breakdown - some were easier to use than others, although all were rated highly by patients. A retrospective chart audit indicated substantial improvements in consistent use of the Braden scale, and the number of risks identified. Completed risk assessments increased by 19.6% to 70%. Initial assessment increased from 16.5% to 44.6%, with identification of dietary insufficiency increasing from 3.4% to 10.6%. Hospital acquired pressure lesions were reduced from 6.4% to 5.8%. The most notable improvement (from 1.3% of patients to 43.9%) occurred in the completion of subsequent pressure risk assessments, with a modest increase in repositioning. The use of overlays and special mattresses increased, with heel raisers increasing from 11% to 82.4%. The project demonstrated the value of a comprehensive team approach to clinical care and demystified evidence-based practice (EBP).