A Performance Improvement Project to Increase Nursing Compliance with Skin Assessments in a Rehabilitation Unit


  • Kathleen Revello BSN RN CRRN,

  • Willa Fields DNSc RN FHIMSS



The aim of this quality improvement project was to increase nursing compliance with skin assessments and ultimately decrease Hospital Acquired Pressure Ulcers (HAPUs) in an acute rehabilitation center.


Interventions in this quality improvement initiative consisted of education, twice-weekly skin rounds, nursing assistant participation, and sharing of pressure ulcer data.


The educational sessions were attended by 80% of the nurses and 95% of the nursing assistants. The remaining nurses and nursing assistants were educated in one-to-one sessions, for a total of 100% of the staff. After the education, skin assessments documentation was completed 100% of the time. The March 2010 CalNOC results demonstrated no patients with HAPUs (Figure 2), which demonstrates a zero incidence of HAPUs since December of 2008.


The education, skin rounds, nursing assistant participation, and sharing of data were instrumental in improving the frequency of skin assessments and the reduction of HAPUs in the rehabilitation unit.

Clinical relevance

Skin rounds and staff education not only increased nursing accountability and improved documentation of wounds but also helped promote the healing of patient's current skin issues.