This power point goes over how an organization can implement and sustain a hospital wide pressure ulcer prevention program using current evidence-based practice.
2. Objectives of a Pressure Ulcer
Prevention Program
â–ş State why a pressure ulcer prevention is important
â–ş Understand how GBMC can initiate and sustain a
pressure ulcer prevention program hospital wide
â–ş Identify best practice in order to diminish the
prevalence of hospital acquired pressure ulcers
â–ş Identify strategies to overcome organizational
obstacles
â–ş Learn how to disseminate new learning
2
3. Why is pressure ulcer prevention
important?
â–ş Pressure ulcers are preventable
â–ş Pressure ulcer occurrence is a quality care
indicator
► Diminishes a person’s quality of life
► Increases a patient’s length of stay
â–ş Reflects negatively on a healthcare organization
â–ş Creates organizational financial hardship
â–ş Prevention is listed as part of The Joint
Commission’s National Patient Safety Goals
3
5. Factors that contribute to the
development of hospital-acquired
pressure ulcers:
â–ş Advanced age
â–ş Inadequate patient mobility
â–ş Severity of illness
â–ş Chronic medical conditions
â–ş Incontinence
â–ş Pain
â–ş Malnutrition
â–ş Cognitive decline
â–ş SICU, MICU, ICU patients 5
6. Clinical areas with high
pressure ulcer prevalence
â–ş ED-patients may wait up to four hours
before being placed in a hospital bed
â–ş ICU-life saving equipment limits mobility
â–ş Critical care settings
â–ş PACU
â–ş Orthopedic unit
â–ş Geriatric unit
6
8. Financial impacts
â–ş Rising prevalence over last 10 years
â–ş Rising healthcare costs
â–ş Hospital acquired pressure ulcers will no longer
be reimbursed by Medicare and Medicaid
â–ş Increases length of hospital stay
â–ş Adds avoidable costs to the healthcare
organization
â–ş Leads to increased litigation
â–ş Pressure ulcer occurrences may negatively
impact future patient referrals 8
9. Potential Organizational
Cost Savings
â–ş For each individual healthcare organization,
between $3 million and $ 4 million a year in
unreimbursed medical expenses
â–ş Investment in pressure redistribution
mattresses had a ROI within 6 months
â–ş Expensive litigation
9
10. How can GBMC initiate a Pressure
Ulcer Prevention Program?
10
11. Assess GBMC readiness for the
implementation of PUP
â–ş Organizational change requires a system- wide
approach
â–ş Determine the level of the leadership commitment
â–ş Recognize barriers to change: workflow,
communication, change in practice, time
â–ş Form small focus groups
â–ş Interdepartmental surveys
â–ş Use toolkit readiness checklist
11
12. Strategies to solidify readiness for a
hospital-wide PUP program
â–ş Pilot a PUP on a high risk unit
 Demonstrate program success in order to obtain
staff support
 Collect and disseminate data of pressure ulcer
prevalence
 Determine individuals interested in becoming
unit-based champions
 Hospital-wide awareness campaigns (posters,
screen savers, town hall meetings, staff
meetings) 12
13. Strategies to overcome
organizational obstacles
â–ş Determine successful processes already in place
â–ş Explain to staff the importance of program
implementation (Federal and State mandates)
â–ş Create urgency to key stakeholders (financial and
clinical benefits)
â–ş Provide leadership and support
â–ş Provide financial and supportive resources
â–ş Listen to staff
13
14. Best practice to eradicate
pressure ulcers
â–ş Identify patients who are high risk by using the
Braden scale & reassess every 12 hours
â–ş Early intervention
â–ş Relieve pressure, reduce moisture
â–ş Reposition every 2 hours
â–ş Digital cameras to assist with documentation
â–ş Hourly rounding to identify patient care needs
â–ş Educate interdepartmental key stakeholders on the
importance of a pressure ulcer prevention program
14
15. Best practice to eradicate
pressure ulcers
â–ş Educate staff, patients, and families
â–ş Assess skin integrity within four hours of
admission to ED
â–ş Develop a daily skin care flow sheet
â–ş Initiate a physician driven order set for high risk
patients
â–ş Interdepartmental collaboration
â–ş Utilize patient identifiers for high risk patients
â–ş Revise policies and guidelines every 2 years and as
needed
â–ş Wound care resource books on each unit
15
16. Measure pressure ulcer rates
â–ş Determine unit pressure ulcer rates for the last 12
months
â–ş Identify units that require immediate intervention
â–ş Use CMS guidelines to create policies and
protocols
â–ş Acknowledge adverse events
â–ş Acknowledge legal action within the organization
â–ş Perform a root-cause analysis with each
documented hospital-acquired pressure ulcer
â–ş Voluntary report to governmental agencies
â–ş Quarterly pressure ulcer prevalence studies
16
17. Education and communication
â–ş Pre-shiftreports
â–ş Nurse-to-nurse reports
â–ş Interdepartmental reports
(ED, OR, PACU, HD,
Out-patient services)
â–ş Unit-based wound/ostomy resource book
â–ş Pressure ulcer prevention champions/teams
17
19. Don’t reinvent the wheel
â–ş Inter-facility
collaboration
â–ş Learn from their success and mistakes
19
20. OSF St. Francis Medical Center in
Peoria, IL
â–ş SOS campaign-SAVE OUR SKIN
â–ş Every two hours, Olympic-style theme music
is piped over the audio system to remind
staff it is time to reposition patients
â–ş Nurses and techs receive a page every two
hours: “Please turn your patients now.”
20
21. Genesis Medical Center in
Davenport, LA
► “TOE”: Turn, Overlay, Elevate
â–ş Turn the patient for prevention
â–ş Overlay beds/chairs with specials surfaces
â–ş Elevate bony prominences and heels
21
22. Owensboro Medical Health System in
Kentucky
► “Four-eyed body check” on admission
â–ş Two nurses check the patient head to toe Q 24 hr
â–ş Patients can refuse which is documented in the
medical record
â–ş Wound rounds bi-weekly
â–ş Identify key people within the organization
â–ş Be consistent
â–ş Track outcomes
22
23. Pennsylvania hospitals introduced a
color of safety
â–ş Color-coded wristbands communicate level
of patient’s risk
â–ş Place a patient identifier outside of the
patients door
â–ş Use color-coded stickers on patients charts
â–ş Be consistent
23
24. Color of Safety
Communicate and Educate
â–ş Initiate
wristbands upon admission or
changes in medical condition
â–ş Educate patients, staff, and family regarding
the purpose of wristbands
â–ş Coordinate signage: doors, chart, stickers to
match wristband color
â–ş Wristband education to facilitate inter-
departmental and inter-facility
communication
24
25. Staff reminders
â–ş Place
a clock with moveable hands as a staff
reminder to turn patients
â–ş Soundsystem or chimes to indicate turning
â–ş Automatic pager timers to direct care staff
25
26. Documentation
â–ş Important in order to comply with state and
governmental standards
â–ş To ensure quality patient care
â–ş Be consistent
â–ş Use available technology
â–ş Photographic documentation
â–ş Key to the defense of legal action
26
27. Resources necessary for
implementation
â–ş Ensure adequate resources:
 Non-clinical time for staff team meetings
 Training and education of staff
 Leadership time to monitor and support teams
 Product and bed product education
 Adequate staff coverage for staff education
 Funds for printed materials
 Information technology changes -- documentation in
electronic patient record
 Performance Improvement -- data system to accurately
reflect pressure ulcer prevalence
27
28. Interdisciplinary teams are key to
PUP success
â–ş Teams need a strong link with leadership
â–ş Teams can generate enthusiastic and
capable leaders with defined unit-based
roles
â–ş Responsible for reporting performance
improvement data and monitoring unit
specific process
â–ş Will be responsible for bringing evidence-
based best practice to the bedside 28
29. Representatives on the PUP team
â–ş Staff nurses
â–ş Risk managers
â–ş Nursing assistants
â–ş Registered dietitians
â–ş Unit managers
â–ş Unit secretary
â–ş Physicians
â–ş PT/OT
â–ş Wound care nurses
â–ş Materials manager
â–ş IT department
29
30. Create a program to
disseminate learning
â–ş Wound care team will be the primary resource for
staff, patients and families
â–ş Unit-based team members will perform skin and
pressure ulcer risk assessments
â–ş The interdisciplinary team will work with staff and
leadership to develop and implement a PUP
program
â–ş Physician champions will educate residents
â–ş Use hospital-side identifiers for persons who are at
high risk for developing pressure ulcers 30
31. Pressure ulcer prevention
sustainability
â–ş Wound care nurses and unit champions will
be responsible for maintaining best practice
â–ş Unit based teams will be expert resources
â–ş Continued leadership support
â–ş New employee orientation
â–ş Yearly competency
â–ş Unit-based PI studies
â–ş Posters
31
32. A pressure ulcer prevention program
requires a team in order to achieve
success and sustainability
32