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McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
McCune Brooks Regional Hospital
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McCune Brooks Regional Hospital

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  • 1. McCUNE-BROOKS REGIONAL HOSPITAL CARTHAGE, MO. PRESSURE ULCER PREVENTION PRESENTATION BY JERRY ROLAND RN, PERFORMANCE IMPROVEMENT COORDINATIOR FOR NURISNG
  • 2. McCune- Brooks Regional Hospital is a state-of-the-art technology driven, compassion led hospital whose mission is to alter the landscape of the healthcare industry and create sincere trust between medical professionals and patients.                 MBRH opened their 145,000 square foot replacement facility in January 2008, featuring 35 private patient rooms,  an expanded women’s  program and ER services, an all new digital Radiology Department and a re-birth of McCune-Brooks’ obstetrics program  including whirlpool baths, family rooms and individualized care.                 The Hospital provides general medical and surgical care for inpatient, outpatient and emergency room patients and participates in the Medicare and Medicaid programs. Emergency room services are available on a 24-hour per day, seven-day per week basis.
  • 3. THE PUPPIES TEAM <ul><li>Clinical Dietician-Debbie Herbst </li></ul><ul><li>Infection Control nurse-Teri Koch </li></ul><ul><li>Point of Care/Patient Documentation-Nila Holmes </li></ul><ul><li>Performance Improvement Coordinator-Jerry Roland </li></ul><ul><li>Home Health Nurse- Patsy Wilson </li></ul><ul><li>Materials Management-Varies </li></ul><ul><li>Nursing Supervisors-Pattie Green </li></ul><ul><li>Clinical med-surg-ICU nurses-Varies </li></ul><ul><li>Physical Therapist-Bill Schmitt </li></ul><ul><li>Nurse Assistant-Varies </li></ul><ul><li>Home Health nurses-Amy Winemiller </li></ul><ul><li>Certified Wound care nurse-Cheryl Cardwell </li></ul><ul><li>Med-surg-ICU wound care nurse-Kim Morris </li></ul><ul><li>Med-surg-ICU unit manager-Janice Duncan </li></ul>
  • 4. Decubitus Prevention Building Blocks PATIENT NUTRITION HYDRATION SKIN CARE CIRCULATION EDUCATION MOBILITY FREE OF FRICTION/SHEERING PATIENT
  • 5. NUTRITION/HYDRATION INTERDISCIPLINARY CARE-MANAGEMENT <ul><li>NURSE TECHS ROUND HOURLY FOR: PAIN – POTTY – POSITION /PRESSURE - HYDRATION…. </li></ul><ul><li>NURSES ROUND IN RESPONSE TO AIDS FINDINS FOR FOLLOW UP ASSESSMENT FOR ALL THE ABOVE…. </li></ul><ul><li>DIET TECHS DO DIETARY SCREENING ON ADMISSION AND EVERY OTHER DAY TO ASSESS NUTRITION/HYDRATION RISK FACTORS…. </li></ul><ul><li>DIETICIAN REVIEWS SCREENS AND FOLLOWS UP ON HIGH RISK PATIENTS…. </li></ul><ul><li>IF DIETICIAN DETERMINES THE PATIENT IS TRULY AT RISK SHE COMPLETES A DIETICIAN ASSESSMENT AND WRITES ORDERS FOR INTERVENTIONS…. </li></ul><ul><li>FOOD PREFERENCES – SUPPLEMENTS – SPECIAL NEEDS ARE NOTED AND SENT TO DIETARY DEPARTMENT…. </li></ul>
  • 6. <ul><li>DIETICIAN’S ORDERS ARE PROCESSED AND WILL NOW SHOW UP ON THE NURSES/TECHS WORKSHEETS…. </li></ul><ul><li>VISUAL CUES ARE PLACED ON INFORMATION BOARDS IN PATIENT ROOMS:A LAMINATED MILKSHAKE FOR SUPPLEMENTS, BANDAID FOR TREATMENTS, A PUPPY FOR “AT RISK”…. </li></ul><ul><li>SUPPLEMENTS ARE LISTED PER NAME AS NEW INTAKE ON NURSING FLOWCHART SO INTAKE IS SPECIFIC FOR THAT SUPPLEMENT…. </li></ul><ul><li>DAILY CONCURRENT MONITORING OF DIETARY SUPPLEMENTS OCCURS…. </li></ul><ul><li>ANY TEXT OF NUTRITION/HYDRATION STATUS PROGRESS FROM THE DIETICIAN’S ASSESSMENT WILL AUTO-FLOW TO THE PRESSURE ULCER HANDOFF TOOL…. </li></ul><ul><li>THE DIETICIAN , THE POINT OF CARE COORDINATOR, AND THE PERFORMANCE IMPROVEMENT COORDINATOR WORK CLOSELY TO ENSURE ALL PROCESS MEASURES ARE WORKING EFFECTIVELY…. </li></ul>
  • 7. NURSING PROCESS IMPROVEMENTS…. <ul><li>NURSE TECHS ROUND HOURLY FOR: PAIN – POTTY – POSITION /PRESSURE - HYDRATION…. </li></ul><ul><li>NURSES ROUND IN RESPONSE TO AIDS FINDINGS FOR FOLLOW UP ASSESSMENT FOR ALL THE ABOVE </li></ul><ul><li>BRADEN SKIN ASSESSMENT ON ADMISSION AND WITH ANY STATUS CHAN GE, AND EVERY THURSDAY…. </li></ul><ul><li>THOROUGH SKIN ASSESSMENT ON ADMISSION AND EVERY 12 HOURS…. </li></ul><ul><li>STANDING PHYSICIAN ORDER SET FOR ALL BRADEN LEVELS, AND ALL STAGES OF PRESSURE ULCERS…. </li></ul><ul><li>STANDING ORDER SETS INCLUDE TREATMENT PROTOCOLS, PRESSURE RELIEF DEVICES, AND ARE USED FOR CODING OF POA PRESSURE ULCERS…. </li></ul>
  • 8. NURSING CON’T…. <ul><li>MRSA SCREENING WITH STANDING ORDERS BUILT IN TO ADMISSION INITIAL INTERVIEW…. </li></ul><ul><li>PRESSURE ULCER DOCUMENTATION SEPERATED OUT FROM OTHER WOUNDS FOR ACCURACY, CONSISTENCY, CONTINUNITY IN STATUS /PROGRESS OF PREVENTION/TREATMENT…. </li></ul><ul><li>IN THE PLANNING/BUILDING STAGE FOR AN ACTIVE WOUND CARE EFORM WITH DISCOVERY/PROGRESS/TREATMENT OF SKIIN CARE ISSUES FROM INCEPTION TO DISCHARGE…. </li></ul><ul><li>NEGOTIAIONS IN PLACE FOR INVOLVING O.R./E.D. IN PRESSURE ULCER PREVENTION PROTOCOLS…. </li></ul><ul><li>CARDIOPULMONARY DEPARTMENT HAS JOINED IN PRESSURE ULCER PREVENTION BY ADDING TO THEIR TREATMENT ROUNDS DOCUMENTATION TO INCLUDE SKIN ASSESSMENT…. </li></ul><ul><li>ROOT CAUSE ANALYSIS OF ANY STAGE II OR GREATER HOSPITAL AQUIRED PRESSURE ULCERS…. </li></ul>
  • 9. NURSING CON’T…. <ul><li>ADDITION OF A FULL SECOND DAY OF SPECIFIC NURSING ORIENTATION TO INCLUDE PRESSURE ULCER PREVENTION/WOUND CARE POLICIES/PROCEDURES/PROCESS AND PROTOCOLS…. </li></ul><ul><li>POLICIES/PROCEDURES UPDATED AS CHANGES OCCUR </li></ul><ul><li>ONGOING MANDATORY NURSING EDUCATION TO DISSEMINATE CHANGES, REVIEW PROTOCOLS, ASSESS QA/PI RESULTS. THIS OCCURS EVERY OTHER MONTH…. </li></ul><ul><li>SPCIALITY SUBGROUP COMMITTEES FOR SPECIFIC AREARS OF EXPERTISE. IE: CLINICAL DIETICIAN REGARDING INCREASED RISK PER NUTRITION/HYDRATION STATUS COMBINED WITH SPECIFIC DISEASE ENTITIES, COMORBIDITIES…. </li></ul><ul><li>INVITATIONS OUTSTANDING FOR ALL AREA NURSING HOMES, INHOUSE MANAGERS ( PURCHASING AGENT, O.R., E.D., HEALTH INFORMATION, ETC…. </li></ul>
  • 10. NURSING CON’T…. <ul><li>POLICIES AND PROCEDURES LISTING EACH STEP OF SKIN ASSESSMENT/PREVENTION/& TREATMENT PROTOCOLS…. </li></ul><ul><li>VISUAL CUES IN THE FORM OF A LAMINATED REWRITEABLE BANDAID ARE PLACED IN PATIENT ROOMS ON THE COMMUNICATION BOARD LISTING TREATMENT PROTOCOLS INDIVIDUALIZED FOR THIS PATIENT…. </li></ul><ul><li>EACH NURSE HAS FLIPBOOK REFERENCE CARDS TO ENSURE ALL PROCESS MEASURES ARE CARRIED OUT, AND HELP WITH STAGING AND TREATMENT PROTOCOLS ETC…. </li></ul><ul><li>CURRENTLY WORKING ON EVIDENCE BASED PATIENT ACQUITY WHICH WILL HAVE THE POTENTIAL FOR ALERTING THE NURSE TO CLINICAL STATUS CHANGES LEADING TO A BRADEN REASSESSMENT…. </li></ul><ul><li>ANNUAL NURSING CLINICAL HANDS ON SKILLS LABS THAT INCLUDE PRESSURE ULCER PREVENTION/WOUND CARE WITH CERTIFIED WOUND CARE NURSE PRESENT…. </li></ul>
  • 11. NURSING CON’T…. PRODUCT REVIEW ONGOING: DRESSINGS, PRESSURE RELIEF DEVICES, SUPPLEMENTS, ETC….
  • 12. COMMUNITY OUTREACH…. <ul><li>LOCAL AREA NURSING HOMES WERE PRESENT AT THE KICKOFF EVENT FOR PRESSURE ULCER PREVENTION PROJECT…. </li></ul><ul><li>CONTACT LISTS WERE GENERATED FOR FOLLOW UP MEETINGS /NOTIFICATIONS…. </li></ul><ul><li>REPRESENTATIVES WERE PRESENT FOR SOME OF THE FUTURE WEBINARS…. </li></ul><ul><li>ONE AREA NURSING HOME SENT THEIR WOUND CARE NURSE TO SHADOW OUR WOUND CARE NURSE FOR THE DAY TO OBSERVE AND EXCHAGE IDEAS…. </li></ul><ul><li>WE SHARED OUR PRESSURE ULCER HANDOFF COMMUNICATION TOOL WITH THESE AREA NURSING HOMES WITH GOOD FEEDBACK RECEIVED…. </li></ul><ul><li>HOME HEALTH HAS BEEN IMPRESSED AND PLEASED WITH THIS NEW HANDOFF COMMUNICATION TOOL UPON DISCHARGE…. </li></ul>
  • 13. COMMUNITY OUTREACH CON’T…. <ul><li>WE’VE ATTEMPTED TO KEEP UP WITH TURNOVER IN PERSONNELL TO STAY CURRENT WITH AREA CONTACTS…. </li></ul><ul><li>INVITATIONS HAVE BEEN EXTENDED FOR ALL PRIMARIS PRESENTATIONS, AND INHOUSE EDUCATION/SKILLS LABS ETC…. </li></ul><ul><li>WE’VE IDENTIFIED PHYSICIAN CHAMPIONS REPRESENTING AREA NURSING HOMES, AND ARE IN THE PROCESS OF BRINGING THEM ONBOARD…. </li></ul><ul><li>GOAL TO ORGANIZE LOCAL PUP GROUP THAT MEETS ON REGULAR BASIS…. </li></ul>
  • 14. INCIDENCE/PREVELANCE…. <ul><li>HEALTH INFORMATION CODES PRESSURE ULCERS FROM OUR WOUND CARE STANDING ODER SETS…. </li></ul><ul><li>ALL STAGES AND POA ARE INCLUDED…. </li></ul><ul><li>ELECTRONICALLY GENERATED REPORTS USING ICD-9 CODES FOR PRESSURE ULCERS CAN BE ACCESSED AT ANY TIME FOR ANY TIME PERIOD…. </li></ul><ul><li>PRIOR TO STARTING THE MISSOURI PRESSURE ULCER PREVENTION PROJECT AND BEFORE POA CODING BEGAN USING STANDING ORDER SETS, FROM 3/1/08 – 2/28/09 THERE WERE 40 CODED CASES OF PRESSURE ULCERS AND AN INPATIENT POPULATION OF 1589 FOR THAT SAME TIME PERIOD = 2.5% PREVELANCE RATE…. </li></ul>
  • 15. INCIDENCE/PREVELANCE CON’T…. <ul><li>3 RD QUARTER: JULY 09 - SEPT. 09 THERE WERE 454 TOTAL INPATIENT ADMISSIONS, OF THOSE ADMISSIONS THERE WERE 21 TOTAL CODED PRESSURE ULCERS = 4.6% PREVELANCE </li></ul><ul><li>18 OF THOSE PRESSURE ULCERS WERE POA = 3.96% FOR POA </li></ul><ul><li>3 OF THOSE PRESSURE ULCERS WERE ACQUIRED = 0.66% INCIDENCE, THIS INCLUDES ALL STAGES …. </li></ul><ul><li>NO STAGE 3 OR 4 PRESSURE ULCERS WERE PRESENT …. </li></ul><ul><li>4 TH QUARTER: OCT 09 – DEC. 09 INCIDENCE AND PREVELANCE REMAINED STATIC…. </li></ul><ul><li>ROOT/CAUSE ANALYSES HAVE SHOWN MULTIFACTORAL CAUSES, BUT IN MOST CASES HANDOFFS/TRANSFERS/STATUS CHANGES/COMMUNICATIONS WERE IDENTIFIED MOST FREQUENTLY…. </li></ul><ul><li>USING THE TEAM STEPPS PROGRAM GUIDE WE HAVE, OR ARE IN THE PROCESS OF IMPLEMENTING SEVERAL MEASURES TO RECTIFY THESE AREAS OF GREATEST CONCERN…. </li></ul>
  • 16. INTERVENTIONS REVIEW…. <ul><li>HOURLY ROUNDING BY BOTH THE NURSE TECHS AND THE CLINICAL NURSES, AS PREVIOUSLY STATED…. </li></ul><ul><li>EVIDENCE BASED PATIENT AQUITY TAKEN FROM ACTUAL CARE RECEIVED BY THE PATIENT, AS DOCUMENTED BY THE CLINICANS…. </li></ul><ul><li>PASS THE BATON CONCEPT BEING IMPLEMENTED AT CHANGE OF STATUS/SHIFT CHANGES/TRANSFERS, ETC…. </li></ul><ul><li>ELECTRONIC REFLEXING ACROSS CLINICAL DEPARTMENTS TO ALERT ALL DISCIPLINES INVOLVED…. </li></ul><ul><li>BOTH NURSING TECHS AND CLINICAL NURSES TAKE PART IN WALKING ROUNDS AT SHIFT CHANGES TO INTRODUCE THEMSELVES AND ENGAGE THE PATIENT AND FAMILY/CAREGIVER IN THE TREATMENT PLAN…. </li></ul><ul><li>VISUAL CUES ARE PRESENT IN PATIENT ROOMS ON COMMUNICATION BOARDS AS REMINDERS FOR INDIVIDUALIZED PATIENT CARE…. </li></ul>
  • 17. INTERVENTIONS CON’T…. <ul><li>ELECTRONIC FORMS/FLOWCHARTS ARE BUILT WITH CLINICAL NURSE INPUT SO BUYIN = COMPLIANCE…. </li></ul><ul><li>ONGOING EDUCATION, SKILLS LABS, SPECIFIC NURSING ORIENTATION, WEBINARS, NETWORKING…. </li></ul><ul><li>CONCURRENT MONITORING OF TARGETS PERFORMANCE INDICATORS FOR NURSING AS REALTED TO AT RISK PATIENTS…. </li></ul><ul><li>CONSTANT EVOLUTION OF THE DISCOVERY/PREVENTION PROCESS…. </li></ul><ul><li>PERSISTANCE TO MAINTAIN A FORWARD MOMEMTUM AND SET BEST PRACTICE STANDARDS ACROSS ALL DISCIPLINES IN HEALTHCARE…. </li></ul><ul><li>MAINTAINING A HIGH ESPIRIT DE CORPS , KEEPING ALL LINES OF COMMUNICATION OPEN, BEING RECEPTIVE TO NEW CONCEPTS, AND SHARING IDEAS/SOLUTIONS WITH ANYONE WHO WANTS/NEEDS ASSISTANCE…. </li></ul>

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