1. REDUCING IN-HOUSE ACQUIRED PRESSURE ULCERS The Long-Term Care Approach By: Yolanda Wingster

2. THE FOCAL POINTS!!

3. PERFORMANCE “STAGING” Stage I Stage I Intact skin with non- blanchable redness of a localized area usually over a bony prominence. Stage II Stage II Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. Stage III Stage III Full thickness tissue loss. Stage IV Stage IV Full thickness tissue loss with exposed bone. Unstageable Unstageable full tissue loss in which actual depth of the ulcer is completely obscured by slough or eschar.

4. THE TEAM Charge Nurse Nurse Manager Certified Nursing Assistant

5. JUST THE FACTS Approximately 1.3 million people develop pressure ulcers each year. According to Joint Commission approximately 60,000 people die from complications caused by pressure ulcers each year. The prevalence of pressure ulcers in long-term care settings range from 2.3%-28%. Cost of treatment for pressure ulcers range from 9.2-15.6 billion dollars in 2008. Almost 87% of verdicts and out of court settlements are awarded to families as a result of the patient acquiring a pressure ulcer.

6. THE PROBLEM  Pressure ulcers can decrease the overall quality of life, related treatment, cause pain, and increase the incidence of death.  Pressure ulcers can increase nursing home cost.

7. CURRENT APPROACH  The Braden Scale is the most commonly used skin assessment tool.

9. STARTING WITH THE BASICS  Turn Schedule  Lubricants/Moisture Barriers  Float Heels  Standard pressure reduction mattress  Weekly skin assessments  Reducing friction and shearing/use of draw sheets  Wheel chair overlay  Air mattress  Heel protectors

10. ACTION PLAN  Continue to identify high risk patients using braden scale  Review patients conditions and diagnoses monthly  Review patient’s medications monthly  Assess mobility status weekly

11. ACTION PLAN CONT…  I dentify potential problems that could place the patient at high risk.  Assess nutritional status weekly (monitor meal intake)  Monitor routine labs as ordered (albumin, prealbumin)  Assess for change in functional abilities  Educate on common pressure areas to assess

12. “PUT IT INTO ACTION”  Implement pressure reduction algorithm to follow upon admission and as needed  Create pressure ulcer compliance sheets, rounds to be completed daily each shift by the charge nurse.  Rounds will assess for compliance of pressure ulcer reduction interventions as care-planned for each patient

13. New Admission No Skin Breakdown Present Incontinence Incontinence Care Proper Briefs Moisture Barrier Prompt Peri Care Decreased Mobility Pressure Reduction Surfaces Heel Protectors Float Heels Turning/Repositioning Below Ideal Body Weight Supplements Dietician Consult Labs Skin Breakdown Present Establish Plan Relieve Pressure Start Vit. C Zinc Multi Vit Moisturize Skin Attempt To Identify Cause Incontinence Bladder/Bowel Incontinent Care Proper Briefs Moisture Barrier Prompt Peri Care Decrease In Mobility Pressure Reduction Surface Heel Protectors Float Heels Turn/Reposition Below Ideal Body Weight Supplement Weekly Weights Dietician Consult Wound Care Algorithm

14. Pressure Ulcer Compliance Form

15. GOALS  Patients skin will remain intact  There will be a reduction in the development of new pressure ulcers  Nurses will be able to better detect high risk patients  The interdisciplinary team will meet weekly on Thursday’s to evaluate the current approach, identify root causes of in-house pressure ulcers, and adjust the current process as necessary.

16. REFERENCES Ayello, E., (2012). Predicting pressure ulcer risk. The Hartford Institute of Geriatric Nursing. Retrieved January 26, 2013, from www.ConsultGeriRN.org Becky, D., Posthauer, E., & Thomas, D., (2009). The role of nutrition in pressure ulcer prevention and treatment: national pressure ulcer advisory panel white paper. Nutrition White Paper. Lynn, J., West, J., & Hausmann, S., (2007). Collaborative clinical quality improvement for pressure ulcers in nursing homes. The American Geriatrics Society. Doi: xdc10.1111/j.1532-5415.2007.01380.x.