35 Wound Improvement Project: Improving Skill Sustainment and Confidence

Abstract

Abstract Introduction New burn intensive care unit (BICU) nurses in the Burn Center complete an evidence-based preceptorship to include standardized wound care education that is reinforced throughout preceptorship. A gap in skill sustainment was identified; factors include lack of a formal sustainment program, inconsistent reinforcement of wound care skills and a perceived decrease in pride in wound care. The purposes of this project are to 1) develop and implement a wound care skill sustainment program 2) re-establish confidence in wound care and 3) improve the quality of wound care delivered in the BICU. Methods A Wound Improvement Project (WIP) committee was formed FEB 2018 consisting 8 BICU nurses; the BICU Nurse Manager and Wound Clinical Nurse Specialist serve as consultants. WIP developed several learning modules and is now developing a wound skill sustainment program and evaluation tool based on the Burn Nurse Competency Initiative (BNCI) standards. BICU staff complete an anonymous survey about wound care confidence every 6 months. WIP mentors and evaluates competency through direct observation during 3 assigned shifts with each BICU nurse. Wound care documentation is audited monthly and a wound care quality audit tool is being developed. Descriptive statistics, student’s T-test, and ANOVA were used. Results The confidence survey was given in Spring 2018 (n=52), Winter 2019 (n=33) and Summer 2019 (n=64); each question showed significant improvement. Notably “how confident would you be doing a full body wound care by yourself with some help turning” improved from 4.12 (±1.17) to 4.64 (±0.65, p=.01). 24 BICU staff have been evaluated with 40 pending completion. No significant difference was found in skill competency between the 3 WIP assigned shifts; however self-evaluation for “how comfortable/confident do you feel advocating for a different type of wound care treatment for your patient” improved from 6.1 (±2.2) to 7.5 (±1.9, p< .0001). Average wound documentation scores improved from 85% in FEB 2018 to 99% in FEB 2019. Conclusions Wound care confidence and documentation have improved since initiation of WIP. Targeted education, bedside tools and workshops have all contributed. There is a positive trend (not significant) towards improved skill competency this is likely due to tool modifications and the small number of staff evaluated to date. Staff feedback has been positive with most staff finding WIP helpful. The long-term goal is to expand WIP to all areas of the Burn Center. Applicability of Research to Practice BNCI standards are a framework for skill sustainment and progression of staff from competent towards proficient and expert. Development and evaluation of nurse-led sustainment programs are needed across the burn community.