Vancouver Coastal Health - Richmond

Pressure Ulcer Prevention

An Interdisciplinary Approach

BCPSQC Quality Forum 2015

Lisa Stewart Maria Torres

Disclosure Statement Both presenters are employees of Vancouver

Coastal Health and declare no potential conflicts of interest.

“A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony

prominence, as a result of pressure, or pressure in combination with shear…”

International NPUAP-EPUAP Pressure Ulcer Definition

Why?

(do we need to be concerned about pressure ulcers?)

Pressure ulcers can develop in less than 12 hours

Prevention is better than treatment

Pressure ulcers have a significant impact on quality of life.

Prevention Strategies = Pressure Ulcers = Quality of Care

Our Strategy

Innovative

Respectful Sustainable

evaluated current state

identified resources

developed the project plan

ActPlan

DoStudy

challenge status quo

Pressure Ulcer Risk Scale completed by the interdisciplinary team at R-Care

Why?(in team rounds?)

Pressure Ulcer risk assessment and care planning is interdisciplinary

Nutrition

Mobility

Activity

Sensory Perception

Moisture

Friction & Sheer

Comorbidities

BMI

Medical Status

Lab Values Medical History

Age

Hydration

…how does this apply to my practice

collaboration

Promotes Awareness within the Interdisciplinary Team

Supports Pressure Ulcer Prevention as part of the team’s standard work

sustainability

DO NOTSTO

P

shared work

The whole is greater than the sum of its parts - Aristotle

Utilization of health discipline expertise

Can the interdisciplinary team efficiently complete the Braden Scale?

Can the interdisciplinary team accurately complete the Braden Scale?

Comparison of Total Braden Scale Score - Interdisciplinary Team and WOCN

0

5

10

15

20

25

30

35

40

IDT Total

WOCN Total

Comparison of Braden Scale Score - Interdisciplinary Team and WOCN

Sensory Moisture Activity Mobility Nutrition Friction and Shear

0

0.5

1

1.5

2

2.5

3

0.18 0.18

0.40.25

0.50.4

√

Pressure Ulcer Prevention

Best Practice

… 5 weeks later

Richmond Hospital Pressure Ulcer Prevention Accreditation Standards Met

Medicine 1 Medicine 2 medicine 3 Surgery 1 Surgery 2 Palliative Care Critical Care0

1

2

3

4

5

Measurement

Richmond Hospital Patients With a Completed Pressure Ulcer Risk Screen (%)

Chart Audit Results

2014 Average 97.3%

January February March April May June July September October December0

20

40

60

80

100

91.298 100 100 99.7 98.6 96 94.6 97.3 97.7

Richmond Hospital Patients with a Completed Pressure Ulcer Risk Screen (%)

January-December 2014

Prevalence & Incidence

What we asked for…

we got more than we asked for…

teams talking

team pride

team ownership

Pressure Ulcers

No Incident

Incident

February 2015

Are we identifying and communicating the risk of a developing pressure ulcer

Can we see it coming?

“The process is great for allowing you to very quickly visually note the problem

areas for that particular patient ultimately allowing you to prevent sores

from progressing”

“Although we all know the key boney areas of the body most at

risk, every patient is different. This form allows for patient

centered documentation and prioritization of your care

strategies and goals”

“Having a designated location and a standardized way of documentation/communication assures us

that patients have their pressure ulcer risks addressed every single day”

“It makes you really think about and consider the high risk skin areas. It also allows the nurse to see what areas may

be of concern specific to that patient and concentrate on their assessment and care

before they progress”

“It is a good tool in that it allows you to see immediately when there has been a

change in a patients skin condition”

January February March April May July August October0

1

2

3

4

5

6

0 0

1 1

0

1

0

5

Pressure Ulcer Prevalence Palliative Care January-October 2014

Pressure Ulcer Prevention in the Operating Room

What?

Be dynamic

Be present

Listen

Say thank you

Did we learn…

Thank you

“Around here, however, we don’t look backwards for very long. We keep

moving forward, opening up new doors

and doing new things…and curiosity

keeps leading us down new paths”

- Walt Disney