Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Dorothea Esposito, PhD(c), DNP MSN/ed, APRN, FNP-BC

Practice Mentor

Maurice Hinson, MD


Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for changes.

Outcome: There was an overall increase of 4.65% in documentation in the skin sections of the EMRs, and a 47/90 (41.11%) increase in all audited charts with words of ashen/ashy gray, dark brown, and purple. In all documented charts, there was a 37/47 (78.72%) increase of the above descriptors. All providers and RNs agreed feeling an increase in knowledge on this subject.

Discussion: Overall, there was an increase in documentation in the skin sections of patient’s charts, and with words of either ashen/ashy gray, darker brown, and purple. In the future this project may be helpful to apply in inpatient settings. The next steps would be to continue expanding on this knowledge and continue teaching providers, and to incorporate a narrative system into the EMR systems.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-Noncommercial-Share Alike 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.