Kennedy Erin
Wayne State University, College of Nursing, Detroit, Michigan, USA
Assistant Professor, Oakland University School of Nursing, Rochester, Michigan, USA.
J Dr Nurs Pract. 2023 Mar 1;16(1):62-80. doi: 10.1891/JDNP-2021-0040.
The skin, surface, keep moving, incontinence/moisture, and nutrition/hydration (SSKIN) bundle is a resource to aid in care planning when at risk of pressure injuries. The bundle uses best practices to minimize variations in care. The objectives of this quality improvement (QI) pilot project were as follows: (a) increase nurses' knowledge of pressure injury prevention, (b) increase nurses' knowledge of the use of the SSKIN bundle, and (c) to pilot the use of an SSKIN bundle in the clinical setting designed to standardize nursing interventions and documentation. Nurses completed a module on pressure injury prevention that included a pre- and posttest to determine knowledge. Education on the use of the SSKIN bundle was provided, followed by a posttest to establish understanding and knowledge gained. The bundle was utilized in the acute inpatient rehabilitation unit for 4 weeks, and compliance was assessed using the "all-or-none" approach (100% compliance). At the conclusion of the pilot project, staff nurses completed a post-survey created by the QI leader (Likert scale format). The survey included topics on the ease of learning to use the bundle, improved knowledge, perceived reduction in variation of care, perceived facilitation of discussion on skin, opinions on whether the bundle should be instituted hospital-wide, and incorporation of the bundle into the electronic health record (EHR). There was an increase in pressure injury prevention knowledge from an average score of 88.89% on the pretest to 98.15% on the posttest. The mean score on the SSKIN bundle posttest was 93.75%. The bundle ran for 4 weeks and was initiated for ten patients during 74 shifts. Compliance with all components of the bundle was 77%. A pressure injury prevention initiative, such as the SSKIN bundle, can be a useful tool to help standardize nursing interventions and documentation. Results revealed Nutrition as the component with the highest degree of noncompliance. Practice recommendations include documenting every patients nutrition information, regardless of Braden score.
皮肤、表面、移动性、失禁/潮湿及营养/水合（SSKIN）集束是一种在面临压力性损伤风险时辅助护理计划制定的资源。该集束采用最佳实践以尽量减少护理差异。本质量改进（QI）试点项目的目标如下：（a）增加护士对压力性损伤预防的知识，（b）增加护士对SSKIN集束使用的知识，以及（c）在临床环境中试点使用SSKIN集束，旨在规范护理干预和记录。护士完成了一个关于压力性损伤预防的模块，其中包括用于确定知识水平的前测和后测。提供了关于SSKIN集束使用的教育，随后进行后测以确定理解情况和所获知识。该集束在急性住院康复单元使用了4周，并采用“全或无”方法（100%依从性）评估依从性。在试点项目结束时， staff护士完成了由QI负责人创建的后调查（李克特量表形式）。该调查包括关于学习使用集束的难易程度、知识改善、护理差异感知减少、对皮肤问题讨论的促进作用、关于是否应在全院推行集束的意见以及将集束纳入电子健康记录（EHR）等主题。压力性损伤预防知识从前测的平均得分88.89%提高到了后测的98.15%。SSKIN集束后测的平均得分是93.75%。该集束运行了4周，在74个班次中针对10名患者启动。对集束所有组成部分的依从率为77%。诸如SSKIN集束这样的压力性损伤预防举措可以是帮助规范护理干预和记录的有用工具。结果显示营养是依从性最差的组成部分。实践建议包括记录每个患者的营养信息，无论其Braden评分如何。
