Pressure Ulcer Prevention

1. Pressure Ulcer Prevention Habersham Medical Center Tallulah Falls Community Group For Regional Two/B

2. Habersham Medical Center • Acute Care Hospital Licensed for 53 Beds. • Long Term Care for 84 Residents • HCMC Home Health Agency • Six Physician Practice Offices • Community Wellness Program

3. Image of Habersham Medical Center

4. Mission Statement • Habersham Medical Center’s mission is to provide high quality caring a compassionate, professional and economical manner to all persons in Habersham County and adjacent areas.

5. In the beginning… • Acknowledging We Had A Problem

6. Listened to our Community • Data did not reflect a need to focus on pressure ulcer prevention. • Identified physician documentation did not routinely include skin assessments and findings. • Available data came from coding from physician documentation only. • Formulated a multidisciplinary Wound Care Team. • Hosted our Tallulah Falls Community meeting with GMCF to address community pressure ulcers.

7. Tallulah Fall Meeting • Met our neighbors to put a face with a name. • Shared preventive measure ideas. • Show and tell for preventive and treatment supplies. • Rep demo tables with available products. • Provide one number to call for all concerns for new admissions that came from HMC.

8. One Phone Number 706-754-3113 Ext: 1121 • This one step was the one step we took that really made a difference. • Gave us real data on pressure ulcers. • Gave HMC real time information to review the patient’s care to see what we could have done differently. • Learned from our lost opportunities. • Peer pressure knowing that everyone was looking, reporting, and reviewing.

9. Formulated Our Team • Physical Therapy • Acute Care Nursing (Med/Surg, ICU, OR) • Material Management • Infection Prevention • Information Technology • Long Term Care Nursing • Home Health Administration • Hospital Administration • Medical Staff to include: • Orthopedics & General Surgery

10. Started In The Basement… • Infection Prevention and Material Management leaders took inventory of all skin prevention and treatment products stocked for all areas. • Reviewed our contracted options. • Contracted companies and trialed products in LTC. • Completed cost analysis on products; contract vs. non contract products. • Approved products and educated staff and Medical Staff.

11. Worksheet for Testing Change

12. GOAL- Evaluate Products • Step One…

13. Step Two

14. Step Three

15. Step Four • DO: • Describe what actually happened when you ran the test of change. • Clear understanding of products stocked and how to use them. • Medical Staff educated for the need of documentation for pressure ulcers overall, to include POA. • Medical Staff educated on products stocked and how to use them. • Trialed different heel boots with no success.

16. Step Five • STUDY: • Describe the measured results and how they compare to the predicted results. • Staff accepted the change of culture and appreciated the team clearing the confusion related to products. • Medical Staff struggled with the culture change focusing on skin and the importance of documentation and assuring the proper products were being used on the patients. • Unexpected barrier with “Boots” to protect the heels. Trials multiple products that took 18 months to finalize the preferred product.

17. Step Six • ACT- • Describe what changes to the plan will be made for the next cycle from what you learned • Continue to monitor or someone will change it without you knowing it… • Set expectations and follow them closely. • Share the responsibility so all team members are engaged. • It is not what you expect as much as what you inspect.

18. Products was just one change

19. Continue to monitor outcomes until you find your facilities solution

20. Community Skin Evaluation Assessment • Tallulah Falls Community Meeting • Braden Scale • Staging of ulcerations • Flow chart different terminology of ulceration • Understanding why certain facilities use different scales and terms.

21. Friction Injury Skin Tear Talking the same talk! Stage II Pressure Ulcer Partial Thickness Burn

22. Wound Rounds • Long Term Care implemented weekly Wound Rounds to include Nursing, Physical Therapy, and Medical Staff. • Implemented Acute Care Wound Rounds- • Started small on one unit, Surgical Unit one day a week at the same time with PT and Nursing • Added ICU to Wound Rounds on Wednesday mornings at 0800. • Graduated to doing Wound Rounds weekly on all units.

23. Wound Education • Annual wound education for all clinical staff. • Demonstrate products and evaluate the staffs knowledge of proper use. • Creative games using scavenger hunt approach. • Convetec and Medline Reps available to answer questions for products. • Chained wound booklets to each nursing area as a reference • Provided Pressure Point Pocket Cards from GMCF

24. Sometimes the problem is bigger than you can fix! • Remembering to stick to the basics before progressing is difficult. We always want to fix everything at once. • Remember time is on your side… • How did our Long Term Care facilities get to zero doing the same things Acute Care is doing?

25. Get them out of bed!

26. Administrative Involvement • Don’t assume they know what you need. • Make sure they understand the financial impact and most importantly the impact it has on the patient’s outcome. • Replaced chairs in patient rooms. • Replaced mattresses and beds.

27. In addition • Hourly Rounding. • Annual Nursing Tech Education to include pressure ulcer prevention. • Wound Vac Certification for Nursing. • Adding POA to our morning rounds with Medical Staff. • Revised documentation in Meditech 6.0 for Wounds • Deleted all TED Hose facility wide.

28. In conclusion… • HMC has eliminated HAC Pressure Ulcerations for nine months. • Evaluate documentation and preventive measures taken on each call received from community. • Use information to continued education. • Provide referred facilities with review findings. • Last known pressure ulcer was August 2011 from a device placed on the patient’s leg. Reviewed the product and usage with Medical Staff and employees. • Take the time and opportunity to learn from your reviews.

29. The End