Sample Process Improvement Plan
Impact of Skin Monitoring Tool on Skin Breakdown
OBJECTIVE:
(Example)
Assess the impact of clinical
intervention on early recognition
and communication of skin
breakdown through
implementation of a new method
of patient bathing which includes
a unique skin monitoring and
communication tool (Comfort
Personal Cleansing® Bath with the
I-See-Red™ Skin Check Guide),
based on:
1.
Improved communication
among caregivers (staff)
2.
Improved maintenance of
skin integrity
3.
Earlier detection of skin
breakdown
4.
Improved communication
with patients
POLICY:
(Example)
The Comfort Personal Cleansing® Bath will be used on all patients requiring bed baths unless a patient
declines or has any known sensitivities to ingredients. If a patient is incontinent, also follow the
incontinence care protocol.
Bathing Patient with Comfort Personal Cleansing® Bath with I-See-Red™ Skin Check Guide
1.
2.
(Example)
20639
1.
PROCEDURE:
(Example)
Background:
(Example)
Your facility’s historical skin
breakdown rates as compared to
current protocol and procedures
with the I-See-Red Skin Check
Guide, which supports JCAHO’s
2005 National Patient Safety Goal
of improving the effectiveness of
communication among caregivers.
In January 2004, skin breakdown
rates housewide were recognized
as high. After review of the
literature and subsequent
implementation of enter current
protocol…here.
RESULTS:
(Example)
3.
4.
5.
Warming the Comfort Personal Cleansing Bath Product
a.
Warm according to directions on the package.
b.
Consult package for complete indications, ingredients and warnings.
Bathing with the Comfort Personal Cleansing Bath
a.
Ensure a private environment.
KEY POINT: Use a towel or sheet to cover the patient appropriately to protect their privacy as
you progress through the bath.
b.
Remove the Skin Check Guide from the bath package and place in an accessible location.
c.
Peel back the package label and test the temperature of the washcloths. If temperature is
acceptable to your touch you may proceed with the bathing process. If not, stop procedure. Repeat
every 10 minutes until temperature is acceptable to patient.
KEY POINT: Remember, gloves diminish your sensitivity to heat. Obtain feedback from your
patient on his or her comfort with the bath. Continue to monitor patient’s comfort level with
temperature as bath progresses.
d.
Remove the first washcloth. Clean the face, neck and upper torso with the #1 washcloth and
discard. No rinsing or drying is required.
KEY POINT: Following the bathing procedure in a sequenced order reduces the chance of cross
contamination by providing a clean washcloth for separate areas of the body while maximizing
appropriate use of the product to prevent waste.
KEY POINT: In patients who have a potential for moisture entrapment in skin folds, it may be
necessary to pat dry with clean soft towel. Use caution around dressings, intravascular lines, etc.
e.
Remove the #2 washcloth. Clean the right arm and armpit with the #2 washcloth and
discard.
f.
Remove the #3 washcloth. Clean the left arm and armpit with the #3 washcloth and discard.
g.
Remove the #4 washcloth. Clean the perineal area with the #4 washcloth and discard. If
patient is incontinent, clean perineal area according to the incontinence care policy and
procedure.
h.
Remove the #5 washcloth. Clean the right leg with the #5 washcloth and discard.
i.
Remove the #6 washcloth. Clean the left leg with the #6 washcloth and discard.
j.
Remove the #7 washcloth. Ask the patient to turn on their side, if able, or obtain assistance,
as necessary. Clean the upper back with the #7 washcloth and discard.
k.
Remove the #8 washcloth. Clean the buttocks with the #8 washcloth and discard. If
additional cleaning in the buttocks region is necessary due to incontinence, refer to
incontinence care policy and procedure.
l.
Once the bath is completed, apply clean gown, cover the patient as appropriate and return
side rails to correct position.
DO NOT FLUSH WASHCLOTHS.
m.
Complete additional personal hygiene activities as necessary (oral care, comb hair and clean
nail beds; wash hair and shave facial hair as necessary).
Educate the patient/family about importance of personal hygiene.
Clean the work environment and leave the patient in a safe, comfortable position. Return
the head of bed to a 30-degree position if no contraindications or discomfort.
Documentation:
a. Using the Skin Check Guide, mark areas of skin redness, irritation, bruising, blistering,
discoloration, cuts/open areas, unusual moles, or any skin condition you are unsure of on the
appropriate body diagram. Document patient ID, location and who completed the skin
monitoring check. If skin monitoring was completed by a nursing assistant, give the
completed guide to the RN assigned to the patient for follow up skin assessment. Otherwise,
place the Skin Check Guide in a designated documentation location as applicable.
b. Document completion of the procedure on your facility’s appropriate form.
Author: Kathleen M. Vollman, MSN, RN, CCNS, CCRN, FCCM
Clinical Nurse Specialist/Educator/Consultant
 ADVANCING NURSING 2004
Note: For “Purpose,” “Articles Needed,” and “References” (used to develop this sample protocol),
download the complete protocol at: www.sageproducts.com/products/skincheck.asp.
This new bathing method (Comfort Personal Cleansing®
Bath with I-See-Red™ Skin Check Guide) enables me to
better meet my unit’s protocol.
Sample Results: You can create
and import your own pie charts or
graphs from information compiled
from your facility’s completed
Clinical Feedback Forms.
2.
Comfort Personal Cleansing
Bath’s one-step cleansing and
moisturizing washcloths
enable me to use my time
more efficiently to monitor
the patient’s skin condition…
10% Agree
90% Strongly Agree
3.
The I-See-Red™ Skin Check Guide is an effective
communication tool between the patient, caregiver and
nurse.
4.
The I-See-Red™ Skin Check Guide is easy to use.
5.
The I-See-Red™ Skin Check Guide is a useful reminder of
the importance of skin monitoring.
6.
I believe this new bathing method is an important
improvement in the quality of patient care at this facility.
Results:
Data through:
Rate = Number of skin breakdowns observed/communicated:
Average prior rate:
Average post rate:
Average length of stay prior to intervention:
Average length of stay post implementation:
Economic Impact:
Average cost of nosocomial pressure ulcer:
Average cost per month prior to intervention:
Average cost per month post implementation:
Savings per month: