Pressure Ulcer Prevention Program


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This power point goes over how an organization can implement and sustain a hospital wide pressure ulcer prevention program using current evidence-based practice.

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Pressure Ulcer Prevention Program

  1. 1. GBMC Pressure UlcerPrevention Program Marie Barry Masters in Leadership/Management Candidate Stevenson University
  2. 2. Objectives of a Pressure Ulcer Prevention Program► State why a pressure ulcer prevention is important► Understand how GBMC can initiate and sustain a pressure ulcer prevention program hospital wide► Identify best practice in order to diminish the prevalence of hospital acquired pressure ulcers► Identify strategies to overcome organizational obstacles► Learn how to disseminate new learning 2
  3. 3. Why is pressure ulcer prevention important?► Pressure ulcers are preventable► Pressure ulcer occurrence is a quality care indicator► Diminishes a person’s quality of life► Increases a patient’s length of stay► Reflects negatively on a healthcare organization► Creates organizational financial hardship► Prevention is listed as part of The Joint Commission’s National Patient Safety Goals 3
  4. 4. Pressure Ulcers listed by Medicare in 2007 as a “never event” 4
  5. 5. Factors that contribute to thedevelopment of hospital-acquired pressure ulcers: ► Advanced age ► Inadequate patient mobility ► Severity of illness ► Chronic medical conditions ► Incontinence ► Pain ► Malnutrition ► Cognitive decline ► SICU, MICU, ICU patients 5
  6. 6. Clinical areas with high pressure ulcer prevalence► ED-patients may wait up to four hours before being placed in a hospital bed► ICU-life saving equipment limits mobility► Critical care settings► PACU► Orthopedic unit► Geriatric unit 6
  7. 7. Diligent nursing care can preventnearly 100% of hospital-acquired pressure ulcers 7
  8. 8. Financial impacts► Rising prevalence over last 10 years► Rising healthcare costs► Hospital acquired pressure ulcers will no longer be reimbursed by Medicare and Medicaid► Increases length of hospital stay► Adds avoidable costs to the healthcare organization► Leads to increased litigation► Pressure ulcer occurrences may negatively impact future patient referrals 8
  9. 9. Potential Organizational Cost Savings► For each individual healthcare organization, between $3 million and $ 4 million a year in unreimbursed medical expenses► Investment in pressure redistribution mattresses had a ROI within 6 months► Expensive litigation 9
  10. 10. How can GBMC initiate a Pressure Ulcer Prevention Program? 10
  11. 11. Assess GBMC readiness for the implementation of PUP► Organizational change requires a system- wide approach► Determine the level of the leadership commitment► Recognize barriers to change: workflow, communication, change in practice, time► Form small focus groups► Interdepartmental surveys► Use toolkit readiness checklist 11
  12. 12. Strategies to solidify readiness for a hospital-wide PUP program► 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. 13. Strategies to overcome organizational obstacles► Determine successful processes already in place► Explain to staff the importance of program implementation (Federal and State mandates)► Create urgency to key stakeholders (financial and clinical benefits)► Provide leadership and support► Provide financial and supportive resources► Listen to staff 13
  14. 14. Best practice to eradicate pressure ulcers► Identify patients who are high risk by using the Braden scale & reassess every 12 hours► Early intervention► Relieve pressure, reduce moisture► Reposition every 2 hours► Digital cameras to assist with documentation► Hourly rounding to identify patient care needs► Educate interdepartmental key stakeholders on the importance of a pressure ulcer prevention program 14
  15. 15. Best practice to eradicate pressure ulcers► Educate staff, patients, and families► Assess skin integrity within four hours of admission to ED► Develop a daily skin care flow sheet► Initiate a physician driven order set for high risk patients► Interdepartmental collaboration► Utilize patient identifiers for high risk patients► Revise policies and guidelines every 2 years and as needed► Wound care resource books on each unit 15
  16. 16. Measure pressure ulcer rates► Determine unit pressure ulcer rates for the last 12 months► Identify units that require immediate intervention► Use CMS guidelines to create policies and protocols► Acknowledge adverse events► Acknowledge legal action within the organization► Perform a root-cause analysis with each documented hospital-acquired pressure ulcer► Voluntary report to governmental agencies► Quarterly pressure ulcer prevalence studies 16
  17. 17. Education and communication► Pre-shiftreports► Nurse-to-nurse reports► Interdepartmental reports (ED, OR, PACU, HD, Out-patient services)► Unit-based wound/ostomy resource book► Pressure ulcer prevention champions/teams 17
  18. 18. Education and communication► Simulationlab for competencies and new nurse orientation 18
  19. 19. Don’t reinvent the wheel► Inter-facility collaboration► Learn from their success and mistakes 19
  20. 20. OSF St. Francis Medical Center in Peoria, IL► SOS campaign-SAVE OUR SKIN► Every two hours, Olympic-style theme music is piped over the audio system to remind staff it is time to reposition patients► Nurses and techs receive a page every two hours: “Please turn your patients now.” 20
  21. 21. Genesis Medical Center in Davenport, LA► “TOE”: Turn, Overlay, Elevate► Turn the patient for prevention► Overlay beds/chairs with specials surfaces► Elevate bony prominences and heels 21
  22. 22. Owensboro Medical Health System in Kentucky► “Four-eyed body check” on admission► Two nurses check the patient head to toe Q 24 hr► Patients can refuse which is documented in the medical record► Wound rounds bi-weekly► Identify key people within the organization► Be consistent► Track outcomes 22
  23. 23. Pennsylvania hospitals introduced a color of safety► Color-coded wristbands communicate level of patient’s risk► Place a patient identifier outside of the patients door► Use color-coded stickers on patients charts► Be consistent 23
  24. 24. Color of Safety Communicate and Educate► Initiate wristbands upon admission or changes in medical condition► Educate patients, staff, and family regarding the purpose of wristbands► Coordinate signage: doors, chart, stickers to match wristband color► Wristband education to facilitate inter- departmental and inter-facility communication 24
  25. 25. Staff reminders► Place a clock with moveable hands as a staff reminder to turn patients► Soundsystem or chimes to indicate turning► Automatic pager timers to direct care staff 25
  26. 26. Documentation► Important in order to comply with state and governmental standards► To ensure quality patient care► Be consistent► Use available technology► Photographic documentation► Key to the defense of legal action 26
  27. 27. Resources necessary for implementation► 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. 28. Interdisciplinary teams are key to PUP success► Teams need a strong link with leadership► Teams can generate enthusiastic and capable leaders with defined unit-based roles► Responsible for reporting performance improvement data and monitoring unit specific process► Will be responsible for bringing evidence- based best practice to the bedside 28
  29. 29. Representatives on the PUP team► Staff nurses► Risk managers► Nursing assistants► Registered dietitians► Unit managers► Unit secretary► Physicians► PT/OT► Wound care nurses► Materials manager► IT department 29
  30. 30. Create a program to disseminate learning► Wound care team will be the primary resource for staff, patients and families► Unit-based team members will perform skin and pressure ulcer risk assessments► The interdisciplinary team will work with staff and leadership to develop and implement a PUP program► Physician champions will educate residents► Use hospital-side identifiers for persons who are at high risk for developing pressure ulcers 30
  31. 31. Pressure ulcer prevention sustainability► Wound care nurses and unit champions will be responsible for maintaining best practice► Unit based teams will be expert resources► Continued leadership support► New employee orientation► Yearly competency► Unit-based PI studies► Posters 31
  32. 32. A pressure ulcer prevention program requires a team in order to achieve success and sustainability 32