2022 Quality Report

Hospital Quality Improvement Showcase - UW Health, Madison

Nurse-Led Research: Improving Pressure Injury Care for Patients with Dark Skin Tones

Understanding skin tone and how it relates to assessment in preventing and identifying pressure injuries and/or tissue damage can be difficult. Research conducted by Health Research & Educational Trust shows us hospital-acquired pressure injuries affect more than 2.5 million Americans annually. Pressure injuries often lead to poor patient outcomes and increased hospital length of stay, negatively impact hospital quality measures and are costly for the hospital system due to reimbursement challenges.

Traditionally, nurses assessing patients’ skin for pressure injury are taught to look for redness to detect the first signs of damage, but this proves challenging when assessing patients with darker-pigmented skin, who require tactile and sensory assessments as well. At UW Health, adult inpatients with dark skin tones had under-recognized and/or misdiagnosed pressure injuries, specifically deep-tissue pressure injuries that result in more severe stages and complications. 

That’s why Courtney Maurer, DNP, RN, chose to conduct her final Doctor of Nursing practice quality improvement project on improving nurse assessment and documentation of pressure injuries specific to dark skin tones. For Courtney, this work was important as racial inequity was sweeping the nation.

“As nurses, we are educated in health care disparities with a focus on racial injustice, public health and chronic diseases, but education and resources on the acute care needs of patients with dark skin are limited,” says Courtney. “I was not confident in my skin assessment skills of patients with dark skin tones, and I recognized a need for organizational resources and further education for inpatient nurses that was inclusive of diverse patient populations.”

She began the improvement project by completing a needs assessment and comparing current documentation and resources with international assessment. In addition, she shared visual examples of different-stage pressure injuries to help nurses better identify pressure wounds on dark skin tones. This work led to engaging UW Health’s diversity, equity and inclusion team, nursing documentation committee and Center for Clinical Knowledge guidelines. She collaborated with UW Health’s Burn and Wound Center team and a clinical nurse specialist to create a translating-research-into-practice-resource sheet and a five-minute video modeling a skin management, nursing informatics and the nursing practice council—all working together to implement recommended terms in the skin and wound nursing documentation flowsheets in our electronic medical record. Courtney worked closely with intensive care unit (ICU) clinical nurse specialists, skin care nurses, the wound team and staff in four adult ICUs at University Hospital, providing pre- and post-surveys to gain understanding of nurse perceptions, attitudes, previous education and resource availability. 

Courtney’s resources can now be found on UW Health’s intranet and are part of the University of Wisconsin School of Nursing curriculum. “I’m finding materials being laminated at nursing stations and on bulletin boards. The feedback from nurses has been positive, and the adoption of documentation changes and resources from other facilities, such as Agrace, the American Family Children’s Hospital and UW Health SwedishAmerican Hospital, has shown the profound need nurses had for these resources.”

Courtney says she hopes this work empowers other nurses to look for ways to improve processes and continue to educate and work together to eliminate disparities in health care outcomes. “I know I can speak for other nurses when I say we feel proud when we know the work we are doing to better ourselves is what’s right for our patients and will ultimately improve the quality of our care.”

For additional information, see the paper detailing this project here