Pressure Ulcer Prevention Program
- 1. GBMC Pressure Ulcer Prevention Program Marie Barry Masters in Leadership/Management Candidate Stevenson University
- 2. Objectives of a Pressure Ulcer Prevention Program ► State why a pressure ulcer prevention is important ► Understand how GBMC can initiate and sustain a pressure ulcer prevention program hospital wide ► Identify best practice in order to diminish the prevalence of hospital acquired pressure ulcers ► Identify strategies to overcome organizational obstacles ► Learn how to disseminate new learning 2
- 3. Why is pressure ulcer prevention important? ► Pressure ulcers are preventable ► Pressure ulcer occurrence is a quality care indicator ► Diminishes a person’s quality of life ► Increases a patient’s length of stay ► Reflects negatively on a healthcare organization ► Creates organizational financial hardship ► Prevention is listed as part of The Joint Commission’s National Patient Safety Goals 3
- 4. Pressure Ulcers listed by Medicare in 2007 as a “never event” 4
- 5. Factors that contribute to the development of hospital-acquired pressure ulcers: ► Advanced age ► Inadequate patient mobility ► Severity of illness ► Chronic medical conditions ► Incontinence ► Pain ► Malnutrition ► Cognitive decline ► SICU, MICU, ICU patients 5
- 6. Clinical areas with high pressure ulcer prevalence ► ED-patients may wait up to four hours before being placed in a hospital bed ► ICU-life saving equipment limits mobility ► Critical care settings ► PACU ► Orthopedic unit ► Geriatric unit 6
- 7. Diligent nursing care can prevent nearly 100% of hospital-acquired pressure ulcers 7
- 8. Financial impacts ► Rising prevalence over last 10 years ► Rising healthcare costs ► Hospital acquired pressure ulcers will no longer be reimbursed by Medicare and Medicaid ► Increases length of hospital stay ► Adds avoidable costs to the healthcare organization ► Leads to increased litigation ► Pressure ulcer occurrences may negatively impact future patient referrals 8
- 9. Potential Organizational Cost Savings ► For each individual healthcare organization, between $3 million and $ 4 million a year in unreimbursed medical expenses ► Investment in pressure redistribution mattresses had a ROI within 6 months ► Expensive litigation 9
- 10. How can GBMC initiate a Pressure Ulcer Prevention Program? 10
- 11. Assess GBMC readiness for the implementation of PUP ► Organizational change requires a system- wide approach ► Determine the level of the leadership commitment ► Recognize barriers to change: workflow, communication, change in practice, time ► Form small focus groups ► Interdepartmental surveys ► Use toolkit readiness checklist 11
- 12. Strategies to solidify readiness for a hospital-wide PUP program ► Pilot a PUP on a high risk unit Demonstrate program success in order to obtain staff support Collect and disseminate data of pressure ulcer prevalence Determine individuals interested in becoming unit-based champions Hospital-wide awareness campaigns (posters, screen savers, town hall meetings, staff meetings) 12
- 13. Strategies to overcome organizational obstacles ► Determine successful processes already in place ► Explain to staff the importance of program implementation (Federal and State mandates) ► Create urgency to key stakeholders (financial and clinical benefits) ► Provide leadership and support ► Provide financial and supportive resources ► Listen to staff 13
- 14. Best practice to eradicate pressure ulcers ► Identify patients who are high risk by using the Braden scale & reassess every 12 hours ► Early intervention ► Relieve pressure, reduce moisture ► Reposition every 2 hours ► Digital cameras to assist with documentation ► Hourly rounding to identify patient care needs ► Educate interdepartmental key stakeholders on the importance of a pressure ulcer prevention program 14
- 15. Best practice to eradicate pressure ulcers ► Educate staff, patients, and families ► Assess skin integrity within four hours of admission to ED ► Develop a daily skin care flow sheet ► Initiate a physician driven order set for high risk patients ► Interdepartmental collaboration ► Utilize patient identifiers for high risk patients ► Revise policies and guidelines every 2 years and as needed ► Wound care resource books on each unit 15
- 16. Measure pressure ulcer rates ► Determine unit pressure ulcer rates for the last 12 months ► Identify units that require immediate intervention ► Use CMS guidelines to create policies and protocols ► Acknowledge adverse events ► Acknowledge legal action within the organization ► Perform a root-cause analysis with each documented hospital-acquired pressure ulcer ► Voluntary report to governmental agencies ► Quarterly pressure ulcer prevalence studies 16
- 17. Education and communication ► Pre-shiftreports ► Nurse-to-nurse reports ► Interdepartmental reports (ED, OR, PACU, HD, Out-patient services) ► Unit-based wound/ostomy resource book ► Pressure ulcer prevention champions/teams 17
- 18. Education and communication ► Simulationlab for competencies and new nurse orientation 18
- 19. Don’t reinvent the wheel ► Inter-facility collaboration ► Learn from their success and mistakes 19
- 20. OSF St. Francis Medical Center in Peoria, IL ► SOS campaign-SAVE OUR SKIN ► Every two hours, Olympic-style theme music is piped over the audio system to remind staff it is time to reposition patients ► Nurses and techs receive a page every two hours: “Please turn your patients now.” 20
- 21. Genesis Medical Center in Davenport, LA ► “TOE”: Turn, Overlay, Elevate ► Turn the patient for prevention ► Overlay beds/chairs with specials surfaces ► Elevate bony prominences and heels 21
- 22. Owensboro Medical Health System in Kentucky ► “Four-eyed body check” on admission ► Two nurses check the patient head to toe Q 24 hr ► Patients can refuse which is documented in the medical record ► Wound rounds bi-weekly ► Identify key people within the organization ► Be consistent ► Track outcomes 22
- 23. Pennsylvania hospitals introduced a color of safety ► Color-coded wristbands communicate level of patient’s risk ► Place a patient identifier outside of the patients door ► Use color-coded stickers on patients charts ► Be consistent 23
- 24. Color of Safety Communicate and Educate ► Initiate wristbands upon admission or changes in medical condition ► Educate patients, staff, and family regarding the purpose of wristbands ► Coordinate signage: doors, chart, stickers to match wristband color ► Wristband education to facilitate inter- departmental and inter-facility communication 24
- 25. Staff reminders ► Place a clock with moveable hands as a staff reminder to turn patients ► Soundsystem or chimes to indicate turning ► Automatic pager timers to direct care staff 25
- 26. Documentation ► Important in order to comply with state and governmental standards ► To ensure quality patient care ► Be consistent ► Use available technology ► Photographic documentation ► Key to the defense of legal action 26
- 27. Resources necessary for implementation ► Ensure adequate resources: Non-clinical time for staff team meetings Training and education of staff Leadership time to monitor and support teams Product and bed product education Adequate staff coverage for staff education Funds for printed materials Information technology changes -- documentation in electronic patient record Performance Improvement -- data system to accurately reflect pressure ulcer prevalence 27
- 28. Interdisciplinary teams are key to PUP success ► Teams need a strong link with leadership ► Teams can generate enthusiastic and capable leaders with defined unit-based roles ► Responsible for reporting performance improvement data and monitoring unit specific process ► Will be responsible for bringing evidence- based best practice to the bedside 28
- 29. Representatives on the PUP team ► Staff nurses ► Risk managers ► Nursing assistants ► Registered dietitians ► Unit managers ► Unit secretary ► Physicians ► PT/OT ► Wound care nurses ► Materials manager ► IT department 29
- 30. Create a program to disseminate learning ► Wound care team will be the primary resource for staff, patients and families ► Unit-based team members will perform skin and pressure ulcer risk assessments ► The interdisciplinary team will work with staff and leadership to develop and implement a PUP program ► Physician champions will educate residents ► Use hospital-side identifiers for persons who are at high risk for developing pressure ulcers 30
- 31. Pressure ulcer prevention sustainability ► Wound care nurses and unit champions will be responsible for maintaining best practice ► Unit based teams will be expert resources ► Continued leadership support ► New employee orientation ► Yearly competency ► Unit-based PI studies ► Posters 31
- 32. A pressure ulcer prevention program requires a team in order to achieve success and sustainability 32