Pressure Ulcer Prevention

Habersham Medical CenterTallulah Falls Community Group

For Regional Two/B

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

Habersham Medical Center

Image of Habersham Medical Center

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.

Mission Statement

Acknowledging We Had A Problem

In the beginning…

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.

Listened to our Community

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.

Tallulah Fall Meeting

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.

One Phone Number 706-

754-3113 Ext: 1121

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

Formulated Our Team

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.

Started In The Basement…

Worksheet for Testing Change

Worksheet for Testing Change

GOAL: (Overall goal you would like to reach)

Every goal will required multiple smaller tests of change

Plan Describe your first (or next) test of change Person Responsible

When to be done

Where to be done

List the tasks needed to set up this test of change Person

Responsible When to be

done Where to be

done

1. 2. 3. 4. 5.

Predict what will happen when the test is carried out Measures to determine if prediction succeeds

1. 2. 3. 4.

1. 2. 3. 4.

Do Describe what actually happened when you ran the test of change

Study Describe the measured results and how they compare to the predicted results

Act Describe what changes to the plan will be made for the next cycle from what you learned

This material was prepared by Alliant | GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 10SOW-GA-IIPC-11-51

Describe your first (or next) test of change Person

ResponsibleWhen to be done

Where to be done

1. Evaluate current products available and newer products on contract for potential use.

Infection Prevention & Material Management

August 2009

Material Management Department

GOAL- Evaluate Products

Step One…

List the tasks needed to set up this test of

changePerson

ResponsibleWhen to be

doneWhere to be

done

1. Schedule time to meet together2. Collect all skin products3. Contact Company for Product Review 4. Complete cost analysis for preferred

products requested.5. Present cost analysis to Administration for

approval.6. Take approval products to Wound Care Team

with Names and Indications

IPMMTMMTIP

IP

MMT

End of week 1August 20th

August 20th

September 1st

September 8th

September 10th

Via OutlookDepartmentMMTIP

Administration

Wound Care Mtg. in September ‘09

Step Two

Predict what will happen when the test is

carried outMeasures to determine if prediction

succeeds

1. LTC would reduce pressure ulceration with a non-contract product

2. Education on all stocked products3. Medical Staff would need to be educated

on products.

1. LTC monitored pressure ulcers with the “butt cream” vs. other product.

2. Completed Library on Skin Products with all Products, Indications, and “How To Use” Instructions was a win for staff satisfaction.

3. Presentation to Medical Staff on products and how to located information on products.

Step Three

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.

Step Four

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.

Step Five

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.

Step Six

Products was just

one change

Continue to monitor

outcomes until you find your facilities solution

Tallulah Falls Community Meeting

Braden Scale Staging of ulcerations Flow chart different terminology of ulceration Understanding why certain facilities use

different scales and terms.

Community Skin Evaluation

Assessment

Talking the same

talk!Skin TearFriction

Injury

Stage II Pressure Ulcer

Partial Thickness Burn

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.

Wound Rounds

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

Wound Education

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?

Sometimes the problem is bigger than you can

fix!

Get them out of bed!

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.

Administrative Involvement

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.

In addition

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.

In conclusion…

The End