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S.O.S. Save Our Skin. Confidential: For Quality Improvement Purposes Only. Reduction of Nosocomial Pressure Ulcers on 5 NEW. Confidential: For Quality Improvement Purposes Only. Physicians: Administration: Terry Light Paul Gorski

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slide1

S.O.S.

Save Our Skin

Confidential: For Quality Improvement Purposes Only

slide2

Reduction of Nosocomial

Pressure Ulcers

on 5 NEW

Confidential: For Quality Improvement Purposes Only

slide3

Physicians:Administration:

Terry Light Paul Gorski

Steve Gnatz Elmer Dulce

Tim Rapp Ewa Jaraczewska

Anthony Rinella

Nursing:Center for Clinical

Mary Vondriska Effectiveness:

Kathy Xenakis Mary Altier

Jodi Blaszcyk Administrative

Victoria Davidson-Bell Assistant:

Yolanda Corral

Confidential: For Quality Improvement Purposes Only

forces of magnetism
Forces of Magnetism

Force 6: Quality of Care

Force 7: Quality Improvement

Force 11: Nurses as Teachers

Force 13: Interdisciplinary Relationships

Confidential: For Quality Improvement Purposes Only

slide5

Opportunity For Improvement

  • Nearly one million people develop pressure ulcers annually while approximately 60,000 acute care patients die from related complications 1
  • Recent data suggest an increase of hospital acquired pressure ulcers on 5NEW.
  • 1 Institute for Healthcare Improvement. Relieve the Pressure and Reduce harm. May 21st, 2007. Accessed at http://ihi.org and http://www.qualityforum.org
  • Reasons identified include:
  • Missing nursing documentation of skin assessment upon admission to unit.
  • RN & PCT knowledge deficit regarding bladder and bowel program.
  • Patients sitting in a chair for too long.
  • Patients wearing ill fitting shoes
  • Actual development of pressure ulcer.
  • No field in EPIC to document healed ulcers.

Confidential: For Quality Improvement Purposes Only

project aim statement
Project Aim Statement
  • Reduction of the pressure ulcer rate below the adult rehab mean
  • Reduction of the incidents of nosocomial pressure ulcers on 5 NEW to zero.

Confidential: For Quality Improvement Purposes Only

slide7

Solutions Implemented

  • Obtained physician support for project.
  • In serviced 100% of RN’s, PCT’s and SC’s on Save Our Skin (SOS) Program.
  • Piloted SOS program beginning 3/03/08 on 5 NEW, including patient, family & staff.
  • BRADEN scale assessment every Wednesday beginning 7/1/08.
  • Implementation of BRADEN scale order sets based on BRADEN scale score.
  • EPIC documentation now includes “HEALED” date.

Confidential: For Quality Improvement Purposes Only

slide8

Solutions Implemented

  • Initiate skin care team consisting of RN’s and PCT’s to perform skin care rounds every Tuesday beginning 3/4/08.
  • Monitor incidence of nosocomial pressure ulcers on 5NEW.
  • Resolve the number of pressure ulcers of patients during their stay on 5NEW.
  • Report outcomes to key stakeholders on a regular basis and post results.
  • Monitor pressure ulcers on a daily basis report results to key staff.
  • Development of EPIC daily report to monitor pressure ulcer prevalence.

Confidential: For Quality Improvement Purposes Only

patient family education
Patient & Family Education
  • Instruct patient & family on reasons for the following:
    • Toileting every 2 hours
    • Elevating heels
    • Pressure relief exercises while in chair
    • Turning every 2 hours while in bed
    • Using a chair cushion
    • Back to bed program

Confidential: For Quality Improvement Purposes Only

slide10

Data demonstrates a decrease in the amount of nosocomial pressure ulcers occurring on 5NEW. 4Q 07 demonstrates a rate below the mean rate.

slide11

Braden scale assessment: recent data shows marked improvement

  • over the last 5 reporting periods. Last 6 reporting periods demonstrate 100% compliance.
slide12

Confidential: For Quality Improvement Purposes Only

Confidential: For Quality Improvement Purposes Only

Increase of number of pressure ulcers in March 2008 related to increase awareness of staff to assess patients and report pressure ulcers.

Confidential: For Quality Improvement Purposes Only

next steps
Next Steps
  • Monitor outcomes of S.O.S program that was instituted in March 2008.
  • Reeducate staff as needed.
  • Monitor number of nosocomial pressure ulcers that are treated and resolved prior to discharge.
  • Monitor BRADEN scale compliance every Wednesday.
  • Collaborate with physical therapy to institute S.O.S program.
  • Celebrate Successes!!!

Confidential: For Quality Improvement Purposes Only

supplies used
Supplies used:
  • Every RN and PCT was given the following tools to facilitate with skin assessments:
    • Pressure Ulcer Assessment Tool
    • Tissue Assessment Guidelines
    • Pressure Ulcer Staging
    • Pressure Point Portrait
    • Hand held mirror to assist in looking at elbows and heels

Confidential: For Quality Improvement Purposes Only