1. Pressure Ulcer Prevention An Interdisciplinary Approach
Vancouver Coastal Health - Richmond
Pressure Ulcer Prevention
An Interdisciplinary Approach
BCPSQC Quality Forum 2015
Lisa Stewart
Maria Torres

2. Disclosure Statement
Both presenters are employees of Vancouver Coastal Health and declare no potential conflicts of interest.

3. International NPUAP-EPUAP Pressure Ulcer Definition
“A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear…”
National/European Pressure ulcer Advisory Panel

4. (do we need to be concerned about pressure ulcers?)
Why?
(do we need to be concerned about pressure ulcers?)

5. Pressure ulcers can develop in less than 12 hours

6. Prevention is better than treatment

7. Pressure ulcers have a significant impact on quality of life.

8. Prevention Strategies = Pressure Ulcers = Quality of Care

10. Our Strategy

11. Innovative
Respectful
Sustainable

12. evaluated current state
Act
Plan Do
Study
evaluated current state
identified resources
developed the project plan

13. Current competency level

14. challenge status quo

15. Pressure Ulcer Risk Scale completed by the interdisciplinary team at R-Care
Challenged current practice adding to the complexity of the change

16. Why?
(in team rounds?)

17. Pressure Ulcer risk assessment and care planning is interdisciplinary
Activity
Moisture
Mobility
Sensory Perception
Nutrition
Pressure Ulcer risk assessment and care planning is interdisciplinary
Hydration
Friction & Sheer
Lab Values
Medical History
1makes sense to bring to interdisciplinary team discussion
Medical Status
Comorbidities
BMI
Age

18. …how does this apply to my practice
We need team members thinking

19. collaboration

20. Promotes Awareness within the Interdisciplinary Team
2. We need all disciplines thinking about PUP in their practice

21. Supports Pressure Ulcer Prevention as part of the team’s standard work
3 sustainability

22. sustainability
DO NOT
STOP

23. shared work
4not about distribution of task. It is about bringing people together to reach a higher level of care. It started as a creative solution that led to positive outcomes that result from a shared goal

24. The whole is greater than the sum of its parts
- Aristotle

25. Utilization of health discipline expertise5

26. Can the interdisciplinary team efficiently complete the Braden Scale?

27. Can the interdisciplinary team accurately complete the Braden Scale?

28. Comparison of Total Braden Scale Score - Interdisciplinary Team and WOCN

29. Comparison of Braden Scale Score - Interdisciplinary Team and WOCN
Average score variation by subscale
Average 0.3

32. √

35. Pressure Ulcer Prevention Best Practice
Mention all 3

37. … 5 weeks later
Challenge was time and competing priorities

38. Richmond Hospital Pressure Ulcer Prevention Accreditation Standards Met

39. Measurement

40. Patients With a Completed Pressure Ulcer Risk Screen (%)
Chart Audit Results
Richmond Hospital
Patients With a Completed Pressure Ulcer Risk Screen (%)

41. 2014 Average 97.3%

42. Prevalence & Incidence

44. What we asked for…
Ask - Snapshot of PU on the unit (each month) with criteria
Method was unit choice

45. we got more than we asked for…

46. teams talking
team pride
team ownership

47. Pressure Ulcers
February 2015
No Incident
Incident

49. Are we identifying and communicating the risk of a developing pressure ulcer
Can we see it coming?

51. “The process is great for allowing you to very quickly visually note the problem areas for that particular patient ultimately allowing you to prevent sores from progressing”

52. “Although we all know the key boney areas of the body most at risk, every patient is different. This form allows for patient centered documentation and prioritization of your care strategies and goals”

53. “Having a designated location and a standardized way of documentation/communication assures us that patients have their pressure ulcer risks addressed every single day”

54. “It makes you really think about and consider the high risk skin areas
“It makes you really think about and consider the high risk skin areas. It also allows the nurse to see what areas may be of concern specific to that patient and concentrate on their assessment and care before they progress”

55. “It is a good tool in that it allows you to see immediately when there has been a change in a patients skin condition”

58. Pressure Ulcer Prevention in the Operating Room

60. What? Did we learn… Be dynamic Be present Listen Say thank you
Dynamic – leadership (lead, direct, facilitate) and flexible in thought
Say thank you

61. Thank you

62. “Around here, however, we don’t look backwards for very long
“Around here, however, we don’t look backwards for very long. We keep moving forward, opening up new doors and doing new things…and curiosity keeps leading us down new paths” Walt Disney