Health Management Team Lowering Pressure Ulcers through Evidence & Process- A spotlight on Gastrointestinal Nursing Health Management Team Lavon Beard Yvette Glenn Britt Mcilwain Daran Brown Cowanda Lawrence Dr. Maria Oquendo Annie Shedlarski

What is a Pressure Ulcer?

Background on W7N

Impact of Pressure Ulcers on Patient Outcomes According to a 2012 UCLA study, “seniors who developed pressure ulcers were more likely to die during their hospital stay, to have longer stays in the hospital, and to be readmitted to the hospital within 30 days of their discharge.” University of California - Los Angeles. October 2, 2012. “Hospital bedsores linked to patient mortality” .Journal of the American Geriatrics Society

UAB Nursing Pressure Ulcer (PU) Bundle A guideline of best evidence-based practice interventions Document comprehensive skin assessment Initiate the Nursing PU Care Protocol if present on admission Document the Braden score For Braden score of 17 or less, initiate the Nursing Skin Care Protocol Document and assess skin on every shift Prevent Skin breakdown using: Barrier cream/wipes; dressings; body aligners; & Waffle boots Turn your patient at least every 2 hours Do NOT over pad the bed Use slide sheets & Safe Patient Handling Equipment Education & Nutrition WOCN Orders And Powernotes ON ADMISSION DAILY CARE PREVENTION The Pressure Ulcer Prevention Bundle is designed as a guideline of best practice interventions and evidence-based components to be used consistently throughout UABH in pressure ulcer prevention and treatment. ON ADMISSION Document if skin intact or not If not intact, complete admission skin assessment documentation and then document further specifics in IVIEW under the Wound/Ostomy/Drains/Tubes band If a pressure ulcer is present on admission, then initiate the Nursing Pressure Ulcer Care Protocol Document the correct Braden score on admission, click on the reference text (Braden Score Component) to view definitions / explanations of score options If the patient has a Braden score of 17 or less, then initiate the Nursing Skin Care Protocol DAILY CARE Document and assess skin on every shift If Braden score decreases to 17 or less then initiate Nursing Skin Care Protocol PREVENTION of PRESSURE ULCERS Use the skin description cards and skin prevention supplies located on the supply carts to prevent skin breakdown Barrier Cream Barrier Wipes Mepilex Dressings Foam body aligners (wedges) Waffle boots Turn your patient at least every 2 hours Do NOT pad the bed, this leads to an increase in pressure ulcers Use slide sheets to move patients and prevent skin tears TREATMENT of PRESSURE ULCERS If a pressure ulcer develops then initiate the Nursing Pressure Ulcer Care Protocol Review the WOCN care orders and follow them Continue the prevention measures listed above EDUCATION and NUTRITION Provide education to the patient and family on pressure ulcer prevention and treatment Have the patient / family watch the Pressure Ulcer Video, video #842 on the TIGR system Provide the patient and family with a copy of the Pressure Ulcer Prevention education located in Depart of IMPACT Ensure that the patient is receiving adequate nutrition or nutritional supplements WOCN ORDERS AND POWERNOTES Wound care instructions are located under patient care and WOCN Orders in Impact. Please read orders and follow correct wound care instructions. Sign, Date, & Time All Dressings. WOCN NOTES are located under Reports and Documents-Consults TREATMENT

New Processes on W7N 1. Admission- Double check by two RN’s 2. How do we ensure accountability Management team active participants- 2 audits per quarter. 3. Quality Huddles each shift A. 10am/10pm quality huddles with pressure ulcer focus B. Sheets used to trace patients progress/deterioration Room # Name Status/Injury Plan Quality Bundle Equip present W754 Cri Healed Sacrum Q2h turns   W747 Rob At Risk ? Q2h turns/WOCN consult W748 Pet Stage 1 sacrum Q3h turns W742 Wat At Risk- sacrum Mepilex- Q2h turns W736 Lof R heel non-blanch, Q2h Waffle boots W734 Fos Purple sacrum/non deep tissue Waffle/Wedge/Mepilex W728 Qui At risk, sutures on bottom Wedge W724 McC At risk W718 Whi W716 Hay

National Database of Nursing Quality Indicators (NDNQI®) How do we Measure our Performance? The Dashboard. National Database of Nursing Quality Indicators (NDNQI®) The measurement of hospital-acquired pressure ulcers allows organizations to: Assess the quality of their care; Evaluate quality improvement initiatives, and; Examine institutional structures and processes that may influence their occurrence. Nursing Quality Chair Oversees the Survey process & Reports results to Hospital & Nursing Quality Councils WOCN Led Teams Trained and certified WOCNs Lead Teams of Trained RN staff In the collection of NDNQI Data Data Analyst Compiles and enters all survey forms into the database

Results: NDNQI for W7N HAPU Success

Results: Control Chart for W7N HAPU

Recommendations & Next Steps Is this a Scalable process throughout UAB Evidence is clear, commitment is the question? The Hawthorne effect is powerful

Discussion