Welcome to Georgia HEN Hospital Acquired Condition

September Affinity Call

September 18, 2013

Julie ApoldJulie Apold is the Sr. Director of Patient Safety at the Minnesota Hospital

Association (MHA) where she has worked with hospitals on patient safety and

quality activities for the past 9 years. She collaborates with the Minnesota

Department of Health to support Minnesota Adverse Health Event Reporting Law

activities; manages the adverse event reporting registry; works with hospitals to

provide guidance on fulfilling reporting requirements and analyzing events for

trends, safety alerts, and improvement opportunities. Julie is currently

managing five state-wide collaboratives to address the top reported adverse

event categories – Pressure Ulcers, Surgical Safety, Retained Objects, and Falls.

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Safe Skin: A Roadmap for Pressure Ulcer Prevention

Julie ApoldDirector of Patient SafetyMinnesota Hospital Association

September 18, 2013

SAFE Skin

S = Skin safety coordinationA = Accurate and concurrent reportingF = Facility expectations, staff educationE = Education for patients and families

S = Skin inspection and risk assessmentK = Keep pressure off I = IncontinenceN = Nutrition is optimized

SAFE Skin Components

Baseline audit using SAFE SKIN Action Plan based on gaps Quarterly SAFE SKIN Updates Concurrent Pressure Ulcer Rate Reporting

• Stages II – Unstageable Quarterly Webinars Pressure Ulcer Advisory Group

• Consensus-based action

Progress on Calls to Action

Baseline 2nd Quarter 6th Quarter 12th Quarter0

20

40

60

80

100

SAFE SKINRoadmap Implementation

% R

oadm

ap C

riter

ia Im

plem

ente

d

Continuous Learning

New Pressure Ulcer Learnings:• 13% related to surgical procedures• 44% device-relatedo Respiratory equipment; immobilizers

• 35% patient condition prohibited shift• 19% patient refused repositioningo Most common reason – patient preference

• 61% occur in ICUo 53% backside; 23% occiput

Recommendation/Guidance

ICU

SAFE Skin Highlights

Safe Skin 2.0• Highlights device-related pressure ulcers• Strategies for high-risk, complex patients• Consistent application of the basics

o Conducting a thorough skin inspectiono Keep patients moving

SAFE Skin 2.0 Roadmap

Roadmap contains 115 questions• Additional Gap Analysis Questions

PSI 3

Q4 2010 (n=103)

Q1 2011 (n=103)

Q2 2011 (n=103)

Q3 2011 (n=103)

Q4 2011 (n=103)

Q1 2012 (n=103)

Q2 2012 (n=103)

Q3 2012 (n=103)

Q4 2012 (n=103)

Q1 2013 (n=110)

0

0.2

0.4

0.6

0.8

1

1.2

0.04

0.04

0.030.11

0

0.040.04 0.07

0.03

0.12

PSI 3 O/E Ratio (Pressure Ulcers) across 100% of Minnesota Hospitals88% below national average

(Q4 2010 - Q1 2013)

PSI 3

PSI 3 Goal

National Average

n = # of hospitals reporting

Rate

Concurrent Reporting

Q4 2010 (n = 14)

Q1 2011 (n = 17)

Q2 2011 (n = 17)

Q3 2011 (n = 20)

Q4 2011 (n = 20)

Q1 2012 (n = 32)

Q2 2012 (n = 25)

Q3 2012 (n = 33)

Q4 2012 (n = 36)

Q1 2013 (n = 73)

Q2 2013 (n = 70)

0

0.2

0.4

0.6

0.8

1

1.2

0.99

0.720000000000001

0.58

0.25

0.48 0.48

0.23

0.54

0.29 0.27

0.17

Average Rate of Pressure Ulcers in Minnesota for 70 (64%) hospitals with a 83% decreaseStages II, III, IV and Unstageable

(Q4 2010 - Q2 2013)

Pressure Ulcer Rate

Goal

Quartern = hospitals reporting

Rate

Key Learnings

Engage the full team • Including RT, OR and Patient/Family

Keep patients moving!! • There are very few patients that cannot be shifted

to some degree Appropriate surface ASAP Devices, Devices, Devices Prior to Safe Skin – Priority = Save the Patient Now - We can save the patient and their skin!

Save Our Skin

Recognizes Skin Teams that “saved the skin” of a complex patient that likely would have developed a pressure ulcer.

SOS Stories

Patient remained hospitalized for 20 months.• Outlined plan for frequent repositioning• Frequently checking bony prominences for signs of

skin breakdown• Consistent core group of nurses• Consistent and frequent site cares

*0 skin related issues*

SOS Stories

Patient in ICU for 2 months.• Small shifts of change every 15 minutes• Skin inspection every 2 hours (or more if any areas

noted for redness)• Body diagram document and detailed shift to shift

report addressing skin• Continuity of care

*0 skin related issues*

Questions?