Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Susie Leming Lee, DNP, MSN, RN, CPHQ
• Committee Member Name & Credentials:
  Debbie Arnow, DNP, MSN, RN, NEA-BC

DNP Project Abstract

Improving Skin Assessments Using Visual Reminders

Purpose
The aim of this quality improvement project was to increase the completion rate of the 4E4H admission skin assessments by RNs in the THH-ICU from 50% to 100% by implementing 4E4H visual reminders placed on the computers used for documentation, and reminder posters placed in east and west staff breakrooms.

Methods
The Model for Improvement was used as the planning and implementation framework. Baseline 4E4H chart audit data from September of 2020 was used to compare to the results of four weeks of 4E4H chart audit data collected after implementation of the visual reminders.

Results
The 4E4H completion rates demonstrated no sustained improvement during the project. The average 4E4H completion rate over the 4-week study period was 50% which was the same completion rate as the baseline completion rate used in this project.  However, there were extenuating circumstances, the COVID-19 pandemic, that may have negatively impacted the results of the project due to nurse emotional exhaustion and fatigue related to caring for the COVID-19 patient population.

Implications for Practice
Although the results of this project did not meet the aim for improving 4E4H admission skin assessment documentation to 100%, improving 4E4H admission skin assessments remains an important mission  to reducing HAPIs on THH-ICU which result in decreased patient length of stay and hospital costs (Bauer, 2016) as well as significant patient suffering (Gorecki, 2009).