S.O.S. Save Our Skin Confidential: For Quality Improvement Purposes Only

Reduction of Nosocomial Pressure Ulcers on 5 NEW Confidential: For Quality Improvement Purposes Only

Physicians: Administration: Terry Light Paul Gorski Steve Gnatz Elmer Dulce Tim Rapp Ewa Jaraczewska Anthony Rinella Nursing: Center for Clinical Mary Vondriska Effectiveness: Kathy Xenakis Mary Altier Jodi Blaszcyk Administrative Victoria Davidson-Bell Assistant: Yolanda Corral Confidential: For Quality Improvement Purposes Only

Forces of Magnetism Force 6: Quality of Care Force 7: Quality Improvement Force 11: Nurses as Teachers Force 13: Interdisciplinary Relationships Confidential: For Quality Improvement Purposes Only

Nearly one million people develop pressure ulcers annually while approximately 60,000 acute care patients die from related complications 1 Recent data suggest an increase of hospital acquired pressure ulcers on 5NEW. 1 Institute for Healthcare Improvement. Relieve the Pressure and Reduce harm. May 21st, Accessed at and Reasons identified include:  Missing nursing documentation of skin assessment upon admission to unit.  RN & PCT knowledge deficit regarding bladder and bowel program.  Patients sitting in a chair for too long.  Patients wearing ill fitting shoes  Actual development of pressure ulcer.  No field in EPIC to document healed ulcers. Opportunity For Improvement Confidential: For Quality Improvement Purposes Only

Project Aim Statement Project Aim Statement Reduction of the pressure ulcer rate below the adult rehab mean Reduction of the incidents of nosocomial pressure ulcers on 5 NEW to zero. Confidential: For Quality Improvement Purposes Only

Obtained physician support for project. In serviced 100% of RN’s, PCT’s and SC’s on Save Our Skin (SOS) Program. Piloted SOS program beginning 3/03/08 on 5 NEW, including patient, family & staff. BRADEN scale assessment every Wednesday beginning 7/1/08. Implementation of BRADEN scale order sets based on BRADEN scale score. EPIC documentation now includes “HEALED” date. Solutions Implemented Confidential: For Quality Improvement Purposes Only

Initiate skin care team consisting of RN’s and PCT’s to perform skin care rounds every Tuesday beginning 3/4/08. Monitor incidence of nosocomial pressure ulcers on 5NEW. Resolve the number of pressure ulcers of patients during their stay on 5NEW. Report outcomes to key stakeholders on a regular basis and post results. Monitor pressure ulcers on a daily basis report results to key staff. Development of EPIC daily report to monitor pressure ulcer prevalence. Solutions Implemented Confidential: For Quality Improvement Purposes Only

Patient & Family Education Instruct patient & family on reasons for the following: Toileting every 2 hoursToileting every 2 hours Elevating heelsElevating heels Pressure relief exercises while in chairPressure relief exercises while in chair Turning every 2 hours while in bedTurning every 2 hours while in bed Using a chair cushionUsing a chair cushion Back to bed programBack to bed program Confidential: For Quality Improvement Purposes Only

Data demonstrates a decrease in the amount of nosocomial pressure ulcers occurring on 5NEW. 4Q 07 demonstrates a rate below the mean rate.

Braden scale assessment: recent data shows marked improvement over the last 5 reporting periods. Last 6 reporting periods demonstrate 100% compliance.

Increase of number of pressure ulcers in March 2008 related to increase awareness of staff to assess patients and report pressure ulcers. Confidential: For Quality Improvement Purposes Only

Next Steps  Monitor outcomes of S.O.S program that was instituted in March  Reeducate staff as needed.  Monitor number of nosocomial pressure ulcers that are treated and resolved prior to discharge.  Monitor BRADEN scale compliance every Wednesday.  Collaborate with physical therapy to institute S.O.S program.  Celebrate Successes!!! Confidential: For Quality Improvement Purposes Only

Supplies used:  Every RN and PCT was given the following tools to facilitate with skin assessments: Pressure Ulcer Assessment ToolPressure Ulcer Assessment Tool Tissue Assessment GuidelinesTissue Assessment Guidelines Pressure Ulcer StagingPressure Ulcer Staging Pressure Point PortraitPressure Point Portrait Hand held mirror to assist in looking at elbows and heelsHand held mirror to assist in looking at elbows and heels Confidential: For Quality Improvement Purposes Only