The wisconsin pressure ulcer coalition wpuc 2011
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The Wisconsin Pressure Ulcer Coalition (WPUC) 2011. Jody Rothe, RN, WCC Quality Consultant January 27, 2011. Objectives. Describe the WPUC structure and how to use the activities to improve your pressure ulcer prevention Determine next steps to improve your pressure ulcer prevention program.

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The wisconsin pressure ulcer coalition wpuc 2011

The Wisconsin Pressure Ulcer Coalition (WPUC) 2011

Jody Rothe, RN, WCC

Quality Consultant

January 27, 2011


Objectives

Objectives

  • Describe the WPUC structure and how to use the activities to improve your pressure ulcer prevention

  • Determine next steps to improve your pressure ulcer prevention program


Thank you

Thank You

  • Thank you for being a 2011 WPUC member

  • Goals of the WPUC

    • Reduce and prevent pressure ulcers

    • Foster cross setting communication


2011 structure

2011 Structure

  • Data submission

  • Monthly e-newsletter

  • Webinars

  • Community meetings

  • Educational DVD

  • Pressure ulcer bundle


Www metastar com

www.metastar.com


Points of quality

Points of Quality


Select setting

Select Setting

Nursing Home Page

Hospital Page


Pressure ulcer web page

Pressure Ulcer Web Page


The wisconsin pressure ulcer coalition wpuc 2011

Data

  • Data collection

  • Data submission

  • Data tracking & analysis

  • E-news data

  • Data tool posted under resources-data:

    • http://www.metastar.com/web/Default.aspx?tabid=339


Data measures

Data Measures

  • Timely Risk Assessment: Number of admissions that have a risk assessment performed within eight hours of admission

    • Numerator: ______________________________

    • Denominator: ______________________________


Data measures cont

Data Measures (Cont.)

  • Timely Skin Assessment: Number of admissions that have a documented comprehensive skin assessment performed with eight hours of admission

    • Numerator: ______________________________

    • Denominator: ______________________________


Data measures cont1

Data Measures (Cont.)

  • Timely Preventive Strategies: Number of patients/residents/clients who receive preventive strategies within 24 hours of being identified as at risk

    • Numerator: ______________________________

    • Denominator: ______________________________


Data measures cont2

Data Measures (Cont.)

  • Pressure Ulcer Prevalence: Number of patients/residents/clients with pressure ulcers at one point in time during the month

    • Numerator: ______________________________

    • Denominator: ______________________________


Data measures cont3

Data Measures (Cont.)

  • Facility Acquired Rate: Number of residents with facility acquired pressure ulcers

    • Numerator: ______________________________

    • Denominator : ______________________________


Data measures cont4

Data Measures (Cont.)

  • Stage of Facility Acquired Pressure Ulcers

    • Stage I _____

    • Stage II _____

    • Stage III _____

    • Stage IV _____

    • Unstageable _____

    • Deep Tissue Injury _____


Data resources

Data Resources


Data tool sample

Data Tool Sample


E newsletter

E-Newsletter

  • Sent monthly via e-mail by Missie Bradley

  • Aggregate data

  • Upcoming events

  • Resources/tips of the month


E newsletter cont

E-Newsletter (Cont.)

  • Submit a question to [email protected] to have the question and answer posted in an e-newsletter

  • Link to resources on website:

    • http://www.metastar.com/web/Default.aspx?tabid=339


Webinars

Webinars

  • Invite will alert members of the webinar

  • Reminders in e-news

  • Three more webinars in the first half of 2011

  • Survey Monkey

  • Past webinars at this link

    • http://www.metastar.com/web/Default.aspx?tabid=342


Community meetings

Community Meetings

  • Why do I need to host a meeting?

  • What do I do with the information?

  • How can the meeting reduce and prevent pressure ulcers?


Community meeting toolkit

Community Meeting Toolkit

  • Community Meeting Toolkit

    • http://www.metastar.com/web/Default.aspx?tabid=339

  • Next Steps


Educational dvd

Educational DVD

  • Mailed to contact listed on enrollment form

  • Cross setting DVD for education of all staff


Pressure ulcer bundle

Pressure Ulcer Bundle

  • How does my team use “The Bundle”?

  • CD sent to the contact on the enrollment form

  • Website Link:

    • http://www.metastar.com/web/Default.aspx?tabid=339


Breaking down the bundle

Breaking Down “The Bundle”

  • Section 1: Organizational Commitment to Pressure Ulcer Prevention & Management

  • Section 2: Pressure Ulcer Prevention & Management Policies

  • Section 3: Educating Staff

  • Section 4: Screening, Assessing & Monitoring Pressure Ulcers


Breaking down the bundle cont

Breaking Down “The Bundle” (Cont.)

  • Section 5: Prevention & Treatment of Pressure Ulcers

  • Section 6: Care Planning for Pressure Ulcers

  • Section 7: Quality Improvement Tools

  • Section 8: References


Section 1 organizational commitment to pressure ulcer prevention management

Section 1: Organizational Commitment to Pressure Ulcer Prevention & Management

  • Commit your organization

  • Institute prevention program based on guidelines (AHCPR, AMDA)

  • Pressure ulcer risk assessments

  • Pressure relief

  • Develop plan of care


Tools for pressure ulcer prevention management

Tools for Pressure Ulcer Prevention & Management

  • Pressure Ulcers:

    • Overview

  • Pressure Ulcers:

    • Essential systems for quality care

  • Flow Diagram:

    • Organizational commitment

  • Checklist:

    • Evaluate key steps for organizational system

  • Plan of Action – Pressure Ulcers:

    • Organizational commitment


Section 2 pressure ulcer prevention management policies

Section 2: Pressure Ulcer Prevention & Management Policies

  • Pressure Ulcer Prevention and Management

  • Assess, revise, develop policy & procedures

  • Develop protocols for screening for pressure ulcer risk

  • Monitoring prevention and treatment

  • Developing care plan


Tools for pressure ulcer prevention management1

Tools For Pressure Ulcer Prevention & Management

  • Checklist provided for assessing pressure ulcer policies

  • Outline of component of a pressure ulcer prevention & management policy

  • Pressure ulcers:

    • Annotated guidelines


Section 3 educating staff

Section 3: Educating Staff

  • Key areas to include in training

  • Screening for resident risk factors

  • Prevention and early treatment options


Key areas to include in staff education

Key Areas to Include in Staff Education

  • Pressure ulcer assessment

  • Monitoring treatment & prevention for residents with pressure ulcers

  • Treatment options for pressure ulcers

  • Accurate documentation

  • Care planning/MDS coordination


Tools for staff education

Tools for Staff Education

  • Checklist:

    • Assessing staff education and training

  • National Pressure Ulcer Advisory Panel Pressure Ulcer Treatment:

    • A competency-based curriculum

  • Content outline


Section 4 screening assessing monitoring pressure ulcers

Section 4: Screening, Assessing, & Monitoring Pressure Ulcers

  • Screening tool should be done upon: admission, readmission, a change in condition, each MDS assessment

  • When performing a pressure ulcer risk screen, the tool should address the following:

    • Impaired mobility

    • Incontinence/moisture

    • Nutritional deficits

    • Altered level of consciousness

    • Altered sensory perception


Assessment monitoring

Assessment & Monitoring

  • Wound assessment should occur upon admission and at specified intervals thereafter. The pressure ulcer assessments should be at least weekly and include:

    • Site/location

    • Size

    • Pain

    • Stage

    • Drainage

    • Appearance

    • Physical health

    • Psychosocial status

    • Nutrition/ hydration status-nutritional assessment

    • Pain status-comprehensive pain assessment


Tools for screening assessing monitoring pressure ulcers

Tools for Screening, Assessing & Monitoring Pressure Ulcers

  • Checklist: screening for pressure ulcer risk

  • Flow diagram-pressure ulcers:

    • Risk Assessment

  • Pressure ulcer risk scales

  • Checklist:

    • Assessment & reassessment & monitoring treatment & prevention of pressure ulcers

  • Assessment and tracking tools examples


Section 5 prevention treatment of pressure ulcers

Section 5: Prevention & Treatment of Pressure Ulcers

  • Early prevention intervention may include:

    • Protecting skin against effects of pressure, friction, & shear

    • Protecting skin from moisture

    • Encouraging optimal nutrition and fluid intake


Treatment

Treatment

  • Clinical Practice Guidelines provide current principles and protocols for prevention and treatment

  • 1996 AMDA Pressure Ulcer Clinical Practice Guideline: Pressure Ulcers

  • 1999 AMDA Clinical Practice Guideline: Pressure Ulcer Therapy Companion

  • AHCPR Clinical Practice Guideline #3: Pressure Ulcers in Adults: Predication and Prevention

  • AHCRP Clinical Practice Guideline #15: Pressure Ulcer Treatment


Tools for prevention treatment

Tools for Prevention & Treatment

  • Pressure Ulcer Prediction & Prevention Algorithm

  • Clinical Algorithm:

    • Management of Pressure Ulcers – Overview

  • Clinical Algorithm:

    • Ulcer Care

  • Clinical Algorithm:

    • Management of Tissue Loads

  • Pressure Ulcers:

    • Communication with Physician

  • Provides a sample form that nursing staff can complete before contacting a physician


Section 6 care planning for pressure ulcers

Section 6: Care Planning for Pressure Ulcers

  • Development of a care plan

  • Interdisciplinary team needs to be involved

  • Areas of risks and interventions should be addressed in the resident’s care plan as they apply to specific problems

  • Education of the resident and family


Care plan

Care Plan

  • Once care plan developed, the process involves:

    • Implementation of the plan of care

    • Monitoring the response to the plan of care

    • Ensuring oversight (person(s) or team) for implementation

    • Reassessment of the plan of care


Tools for care planning

Tools for Care Planning

  • Checklist:

    • Developing a pressure ulcer care plan

  • Education tool for residents & families:

    • Pressure ulcers


Section 7 quality improvement

Section 7: Quality Improvement

  • A systems approach to Quality Improvement

  • Through analysis of current process that make up the systems, the Pressure Ulcer Quality Improvement Workgroup can determine which problems are areas that need improvement


Tools for quality improvement

Tools For Quality Improvement

  • Worksheets

  • Plan of Action – Pressure Ulcers:

    • Organizational commitment


Root cause analysis

Root Cause Analysis


Section 8 references

Section 8: References

  • Pressure Ulcer Reduction and Prevention Project “The Bundle”


The six elements of ihi bundle

The Six Elements of IHI Bundle

  • Conduct a pressure ulcer admission assessment for all patients

  • Reassess risk for all patients daily

  • Inspect skin daily

  • Manage moisture: keep patient dry & moisturize skin

  • Optimize nutrition and hydration

  • Minimize pressure


Pressure ulcer admission risk skin assessment

Pressure Ulcer Admission Risk & Skin Assessment

  • Conduct

    • For all patients

    • For risk

    • For detection

  • Gather data

    • Braden Scale, Norton Scale


Daily risk reassessment

Daily Risk Reassessment

  • Triggers

    • Mobility

    • Incontinence

    • Nutrition

    • Procedures

  • Preventive Steps

    • Policy & procedure


Inspect skin daily

Inspect Skin Daily

  • Conduct

    • For those at risk

    • Areas of potential pressure

      • Sacrum

      • Back

      • Buttocks

      • Heels

      • Elbows

      • Device related


Manage moisture keep patient dry moisturize skin

Manage Moisture: Keep Patient Dry & Moisturize Skin

  • Manage moisture

    • Minimize exposure

    • Products to absorb moisture

    • Topical agents

  • Be proactive

    • Take advantage of grouping tasks

    • Be prepared with supplies at hand


Optimize nutrition hydration

Optimize Nutrition & Hydration

  • Use a team approach

    • Include dietician early

    • Ask all caretakers to assess & report back

    • Offer the nutritional plan in the grouping of tasks

    • Make sure documentation is complete

    • Engage family

      • Family Fact Sheet at www.ihi.org


Minimize pressure

Minimize Pressure

  • Use cues to turn/reposition patients every two hours

  • Keep supplies in patient rooms

  • Assess for use of re-distribution surfaces

  • Use turning techniques

    • Prevent friction & shear injury


Tips for success

Tips for Success

  • Post data for staff & educate them

  • Name the project

  • Consider a pressure ulcer unit champion

  • Determine ownership of documentation

    • RN, CNA, staff helping patient is this clear?

  • Identify barriers to address

    • Saying not enough staff is an excuse


Qi tools techniques

QI Tools & Techniques

  • Pressure Sore Data Collection Skin Assessment Tool

  • Braden or Norton Scale

  • Wound Care Competency Tool

  • Pressure Ulcer Prevention Points Tool

  • NJHA Pressure Ulcer Prediction, Prevention & Treatment Pathway


Quality improvement

Quality Improvement

  • Use the resources to determine an action plan with your team

  • Tool-Prevention Action Plans

    • http://www.metastar.com/web/Default.aspx?tabid=339


In summary

In Summary

  • Describe the WPUC structure and how to use the activities to improve your pressure ulcer prevention

  • Determine next steps to improve your pressure ulcer prevention program

  • Develop plan to maximize WPUC activities to reach goals of reducing and preventing pressure ulcers while fostering cross setting communication


Contact information

Contact Information:

MetaStar, Inc.

2909 Landmark Place

Madison, WI 53713

(608) 274-1940 or (800) 362-2320

Ext. 8271

www.metastar.com

[email protected]

PRIV-WI-MISC-11-07


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