Four Eyes in Four Hours: A Commitment to Patient Safety

smilng female doctor holding a tablet with patient

You can’t treat what you don’t see. That’s the premise behind an initiative that’s improving patient safety and quality at University of Missouri Health Care’s University Hospital.

It started in 2016, when a group of nurses attended a national wound-care conference and heard about the “Four Eyes in Four Hours” program. The point is to identify all of a patient’s wounds, such as bed sores or pressure ulcers, during admission. The program requires two nurses to each provide a full-body skin assessment within four hours of admitting a patient.

As a tertiary referral center and Level 1 trauma center, MU Health Care treats patients from across the state who are often are transferred to MU Health Care from other hospitals and arrive with multiple chronic conditions and complex health care needs.

“The admission process is critical, especially when someone is coming from the Emergency Department and they are being admitted with a serious, acute condition,” said Lauren Bridgman, RN, a program coordinator on MU Health Care’s skin, wound and ostomy team. “There are a lot of things you’re focusing on to save that person’s life. We want to promote a very good skin assessment within four hours of admission.”

Bridgman coordinates the “Four Eyes in Four Hours” program at University Hospital. She works with each hospital unit to ensure patients are examined by two nurse evaluators each time they are transferred to another unit.

“Documenting these wounds gives us a baseline so we can treat any identified injuries, monitor them and prevent patients from developing hospital-acquired pressure injuries,” Bridgman said.

If wounds are discovered upon evaluation, the nurse documents them and notifies a specialized skin-care team that can help decide on the best treatment. The skin-care team also educates nurses throughout the organization what can be done on a shift basis to make sure patients aren’t developing pressure injuries.

The program started in August 2016 as part of MU Health Care's commitment to patient safety and continuous quality improvement. The skin-care team receives daily and weekly audits for each unit in the hospital.

“We are able to see how many people were admitted, how many of those admitted received the dual skin assessments and how many of those assessments were documented within four hours,” Bridgman said.

The results are impressive. The number of wounds identified upon admission increased by nearly 30 percent in the first six months, while the number of hospital acquired pressure injuries decreased by 45 percent. 

“The thorough skin evaluations make the patients feel a whole lot better, even though they don’t feel well when they come in,” said MU Health Care nurse Heather Libby, RN. “Two nurses are looking them over and documenting everything. It really helps round out the whole experience, and this helps them to feel they are getting them the best care possible.”

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