Abstract：
OBJECTIVE: The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting.
METHODS: This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.
METHODS: The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.
RESULTS: Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.
CONCLUSIONS: The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.
METHODS: This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.
METHODS: The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.
RESULTS: Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.
CONCLUSIONS: The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.
摘要：
目的：此质量改进项目的目的是使用增强的皮肤评估（深色皮肤的皮肤评估，SADS）和卤素照明。
方法：该质量改进项目是在密歇根州东南部一家大型大学教学医院的3个单位进行的。该项目最初的设计是为了使参与的患者被床边护士识别为具有足够的黑色素，可以使用常规照明来掩盖手/前臂的漂白，但是这个目标没有实现。数据分析基于自我识别为非洲裔美国人或黑人的患者，夏威夷原住民或太平洋岛民，亚洲人,美洲印第安人,和阿拉斯加原住民。参与该项目的床边护士还被要求填写一份问卷，描述他们对该项目的知识和经验，并评估肤色较深的患者的早期PI。
方法：爱荷华州循证实践模型用于指导这项质量改进计划。在触发事件之后，我们回顾了相关文献,并开发了一种增强技术来评估肤色较深的患者,该技术涉及使用卤素照明(SADS)和记录结果.我们从我们的设施中选择了单位，并教导护士应用SADS方法。使用来自电子病历的数据和对参与护士的调查来比较项目实施前后的发现。比较基于描述性数据分析。
结果：实施增强的身体评估后，在实施期间，参与单位的设施获得的PI总数减少了6%。
结论：增强的身体评估，当与卤素照明配对时，在深色皮肤的人中增强了阶段1PI的识别。评估方法易于教学，学习,并且可以在床边进行轮班评估的一部分，通常包括皮肤检查。
方法：该质量改进项目是在密歇根州东南部一家大型大学教学医院的3个单位进行的。该项目最初的设计是为了使参与的患者被床边护士识别为具有足够的黑色素，可以使用常规照明来掩盖手/前臂的漂白，但是这个目标没有实现。数据分析基于自我识别为非洲裔美国人或黑人的患者，夏威夷原住民或太平洋岛民，亚洲人,美洲印第安人,和阿拉斯加原住民。参与该项目的床边护士还被要求填写一份问卷，描述他们对该项目的知识和经验，并评估肤色较深的患者的早期PI。
方法：爱荷华州循证实践模型用于指导这项质量改进计划。在触发事件之后，我们回顾了相关文献,并开发了一种增强技术来评估肤色较深的患者,该技术涉及使用卤素照明(SADS)和记录结果.我们从我们的设施中选择了单位，并教导护士应用SADS方法。使用来自电子病历的数据和对参与护士的调查来比较项目实施前后的发现。比较基于描述性数据分析。
结果：实施增强的身体评估后，在实施期间，参与单位的设施获得的PI总数减少了6%。
结论：增强的身体评估，当与卤素照明配对时，在深色皮肤的人中增强了阶段1PI的识别。评估方法易于教学，学习,并且可以在床边进行轮班评估的一部分，通常包括皮肤检查。
