PfP NJ 2.0 Pressure Ulcer Prevention Learning Action Group Webinar - - PowerPoint PPT Presentation
PfP NJ 2.0 Pressure Ulcer Prevention Learning Action Group Webinar #4: Inside Look into Pressure Ulcer Prevention with NJ Best Practice Hospitals August 30, 2016 Hosted by New Jersey Hospital Association Lauren Rava, MPP Collaborative
Hosted by New Jersey Hospital Association Lauren Rava, MPP Collaborative Faculty Capital Health Kim Coleman MSN, RN, APN,C, Susan Bell MSN, RN, CWOCN & Amanda Liebenberg BSN, RN University Medical Center of Princeton
*It is important to note a data anomaly for the fall and falls with injury rates for first quarter 2015. The data shows a dramatic increase in rates. There are a couple of possibilities. One, 2015 was a particularly harsh winter and this could have possibly led to increase in falls due the effect with the elderly
the issue and will update with our findings.
3.35 2.79 2.82 2.34 2.53 2.17 2.33 2.30 2.50 y = -0.1007x + 3.0721 R² = 0.5695 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 2011 (n=32) 2012 (n=33) 2013 (n=32) 2014 (n=29) 2015Q1 (n=55) 2015Q2 (n=54) 2015Q3 (n=54) 2015Q4 (n=54) 2016Q1 (n=52)
HAPU Rate
Hospital-Acquired Pressure Ulcers Stage 2+ per 100 Patient Days (NDNQI measure)
NJHEN 40% Target (2.01) NJHEN Baseline (3.35) National Benchmark (1.982)
1.96 1.69 1.53 1.49 1.36 1.07 0.89 0.44 y = -0.1926x + 2.1711 R² = 0.9457 0.0 0.5 1.0 1.5 2.0 2.5 2011 (n=67) 2012 (n=67) 2013 (n=67) 2014 (n=68) 2015Q1 (n=68) 2015Q2 (n=68) 2015Q3 (n=68) 2015Q4 (n=67)
PSI-03: Decubitis Ulcer Rate
Pressure Ulcers Stage III or IV per 1,000 Discharges > 4 days (AHRQ measure)
NJHEN 40% Target (1.18) NJHEN Baseline (1.96) National Benchmark (0.246)
90.7% 95.3% 97.8% 97.1% 97.5% 97.3% 97.1% 98.1% 98.0% 86% 88% 90% 92% 94% 96% 98% 100% 2011 (n=35) 2012 (n=40) 2013 (n=38) 2014 (n=32) 2015Q1 (n=54) 2015Q2 (n=53) 2015Q3 (n=53) 2015Q4 (n=51) 2016Q1 (n=51)
Pressure Ulcer Risk Assessment
% of Patients Assessed for Pressure Ulcer Risk w/in 24 Hours of Admission (NDNQI measure)
89.5% 90.9% 90.0% 91.4% 91.0% 90.3% 91.4% 91.6% 92.2% 88% 89% 89% 90% 90% 91% 91% 92% 92% 93% 2011 (n=34) 2012 (n=35) 2013 (n=33) 2014 (n=31) 2015Q1 (n=53) 2015Q2 (n=53) 2015Q3 (n=52) 2015Q4 (n=52) 2016Q1 (n=51)
Pressure Ulcer Preventive Care for At-Risk Patients
% of At-Risk Patients Receiving ≥ 3 Preventive Strategies w/in 24 Hours (NDNQI measure)
Patient
Communi cate
Educate Evaluate
Skin Integrity Team Wound Program Manager Administration Representative Unit Champions Medical Director Program Managers Quality / Education / Prevention Unit Managers / CNLs Environmental Services Materials Management
Physical Therapy
Review ‘Best Practice’ Guidelines Identify ‘At Risk’ patients requiring proactive preventive intervention
Skin assessments are completed:
Within 4 hours of admission Every shift and With a change in condition. The EMR triggers for skin assessment each shift.
Facility-wide Communication
Safety Call Inter-departmental briefings
Patient/unit specific communication EMR triggers
Individualized care plans Hand-off and shift reports
Multidisciplinary SIT Chart Audits Performance Improvement Reports Individualized care plans Incidence report follow-up by Wound Nurse
Staff
One on one (WCC/champion with bedside nurse)
risk issues
Patients / Families / Caregivers
Initiate an Interdisciplinary Team Approach Identification
Patients ‘At Risk Skin ‘At Risk’ Evidence-based interventions and products
Communication
Facility- wide Patient / Unit specfic
Evaluation
Multiple avenues
Education
Staff / Patients / Caregivers
1.National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory
2.Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of
at: www.ahrq.gov/ professionals/ systems/ hospital/ pressureulcertoolkit/ index.ht ml 3.Niederhauser A, et al. Comprehensive programs for preventing pressure ulcers: a review of literature. Adv. S kin Wound. 2012:25(4;167-88.
antamaria N, Gerdtz M, S age S , et al. A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial. Int Wound J 2013. DOI: 10.1111/ iwj .12101.
, et al. Use of a soft silicone, self adherent foam dressing to reduce pressure ulcer formation in high risk patients: A randonimzed clinical
Ostomy Continence Nurs. 2013:403S :S 2-3.
CDC data http://cdc.gov/nchs Year Both Sexes Male Female 2000 76.5 yrs 74.1 yrs 79.3 yrs 2009 78.5 yrs 76.0 yrs 80.9 yrs 2015 76.3 yrs 76.3 yrs 81.3 yrs
– Mercer Medical Center and Helene Fuld Medical Center merged – Skin/Wound Care Committees united – Skin Care Task Force (SCTF)
– RNs from
– Ancillary Departments
– Participates in monthly meetings
– Concurrent audit vs retrospective audit – Identify those patients at risk – Implement pressure ulcer prevention modalities – Monitor and reassess the care plan – Monitor nosocomial rate
– Collected weekly by SCTF rep
– Types of ulcers, staging – Importance of accurate data collection – Ethics of data collection – Interpreting data results
– Data collected for patients with pressure ulcers – Sent to Nursing System Analyst monthly – Received analysis 1-2 months AFTER collection – Data results presented to SCTF – SCTF would share results with unit
– Shared Folders early 2000 – Real Time Information
CHSWorld (Intranet)
passwords
Spreadsheet
data analysis immediately
immediately
– Using Excel – Secured personal desk top PCs necessary – Unable to utilize shared folders
Users can select the area in which they need to enter data User able to visualize Nosocomial and Pressure Ulcer Prevalence Rates
User Friendly data entry screen Many categories allow user to select from drop-down
consistent
Users are able to view data in a variety of different graph applications:
– Data presented at monthly meetings and to individualized units
– Orientation – Mandatory yearly competencies – Documentation, staging, incontinence care, Risk factors, Bariatric focus – NDNQI Pressure Ulcer Training Module yearly – Resources such as Intranet Wound Care Manual
Management of Pressure Ulcers (Injuries): WOCN Clinical Practice Guidelines Series. www.guideline.gov
Summit: Interprofessional and interorganizational collaboration to operationalize best practice recommendations for hospital acquired pressure ulcer prevention. J Wound Ostomy, Continence Nurs. 42(4): 331-337.
hospital- acquired pressure ulcer prevention programs in U.S. Academic Medical Centers J Wound Ostomy Continence Nurs. 42 (4) : 327-330.