Leading the Patient Safety Charge - Keeping Our Patients Wound Free 2019 Minogue Distinguished Achievement in Patient Safety Innovation Award

Transcription

1 Leading the Patient Safety Charge - Keeping Our Patients Wound Free 2019 Minogue Distinguished Achievement in Patient Safety Innovation Award Levindale Hebrew Geriatric Center and Specialty Hospital Barbara Quinn RN, BSN, CWON, WCC Marian Chima MSN, RN, CDE April 5, 2019

2 By the end of this presentation, the audience will be knowledgeable of Levindale s: Mission and Services Unique Scope of the Wound Prevention Program Treatment Team o Who We Are o How We Have Trained o What We Do Lesson s Learned Along Our Journey Objectives

3 Our Mission Levindale is a geriatric center and hospital dedicated to providing superior service for the aging, frail and ill in institutional, community and home settings. As an advocate for the elderly, Levindale accepts a leadership role in defining and developing, in collaboration with other agencies, a comprehensive continuum of nursing, medical and social services within the Jewish community of the Baltimore metropolitan area. Programs are operated within the values inherent in Judaism pursuant to Levindale's charter. As part of our Eden Alternative and Neighborhood Model programs, we are committed to creating an environment that promotes the celebration of life. L'Chaim (To Life)!

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5 About Levindale Levindale was founded in 1890 as the Hebrew Friendly Inn. For 125 years, Levindale has been providing quality health care and forward-looking programs for people who are elderly and disabled. In 1996, Levindale joined Sinai Hospital to form the Sinai Health System. In 1998, Sinai Health merged with Northwest Hospital to become LifeBridge Health.

6 Levindale by the Numbers Levindale is a 330 bed facility. The Skilled Nursing Facility at Levindale consists of: 210 dually certified beds: Sub-acute unit Two dementia care Households Respiratory Care Unit Vent Care Traditional LTC Units and Households The Specialty Hospital at Levindale consists of: 120 chronic beds: High Intensity Care Unit Behavioral Health Units

7 Our Services Cardiology Geriatric Medicine Dentistry Internal Medicine Ear, Nose and Throat Ophthalmology Podiatry Psychiatry Pulmonology Radiology Rehabilitation Medicine Urology

8 Education Programs Pharmacy Nursing Assistants Rehabilitation Therapies Medical Social Work Rehabilitation Medicine Nursing Physician Assistant Dental Nurse Practitioner Urology

9 Levindale s Wound Care Program

10 Set treatment goals consistent with the values and goals of the individual while considering family input. Promote wound healing Prevent complications Avoid deterioration of existing wounds prevent additional skin breakdown

11 Treatment Team Nurses including RNs, LPNs, and CMAs Certified Wound Ostomy Nurse (CWON) Wound Care Certified (WCC) staff

12 Treatment Team Initiates wound prevention bundle orders Assesses and stages wounds Provides wound care Monitors status of wounds Rounds weekly Educates frontline staff Promotes interdisciplinary collaboration

13 What Makes Us Special We treat all wounds Wound rounds LVAD drive site care

14 Lifebridge Health Collaboration Partner with Northwest Hospital Wound Center Quarterly meetings with CWOCNs

15 Chair cushions Mattress overlays Own specialty beds Levindale Offers..

16 Physical Therapy Involvement Wound Certified Physical Therapists Wide variety of wound care products

17 Skin Champions (added in 2017) Rehab Quality Directors Dieticians Education Managers EVS (beds) Levindale s Skin Committee Infection Control CNO/Administration Product Analysis Committee

18 FY 2013: Identifying the Problem 191 Pressure Injuries Why? How? Who?

19 Plan Do Act Study

20 FY 2014 Pressure Injury Reduction Initiatives Prevention bundle re-evaluated for effectiveness Prevention rounds initiated Electronic Medical Record (EMR) Created wound documentation sheet Electronic wound rounds documentation created

21 Prevention Bundle Order Set Specialty bed Turning orders in bed and chair Pillow boots Pillow under the calf Foley securement device G-tube securement device Foam prevention dressing sacral and heel Barrier cream orders

22 Why Prevention Rounding Prevention orders implemented Assessed 100% of patients Findings reported monthly On the spot education Accountability

23 Prevention Rounds Checklist

24 FY 2014 Results 121 Injuries House-Wide 37% reduction from FY 2013 More improvement opportunities exist!!!

25 FY 2015 Pressure Injury Reduction Initiatives Prevention rounding continues Specialty Hospital EMR documentation Nationwide Benchmarking with Prevalence study Treatment Team Newsletter Wound of the Week

26 Improved Electronic Medical Record Documentation Increased frequency of Braden Scale Assessment Shared results in nursing hand-off Identified trends and issues

27 Treatment Team Newsletter

28 Wound of the Week Left Ear: What are you looking at? What should you do?

29 ANSWER Cancer. CELLS GONE WILD!! Malignant wounds are caused by infiltration of the epidermis by the primary or metastic tumor (the cancer cells actually grow into and through the skin). What to do: Use a non-stick dressing like Xeroform or Adaptic. Some cancerous wounds may have an odor. Chlorapaction/Vashe is a great cleanser to reduce odor. Never debride malignant wounds. NPWT (wound vac) is contraindicated with malignant wounds. Obtain surgical consult for any wound that is cancerous.

30 FY 2015 Results 87 Injuries House-Wide 54% reduction from FY % reduction from FY 2014 We need to do more!

31 FY 2016 Pressure Injury Reduction Initiatives PUPP Program Skills Day Prevention Dressings New Employee Orientation

32 New Employee Orientation

33 Foam Prevention Dressing

34 FY 2016 Results 48 Injuries House-Wide 75% reduction from FY % reduction from FY 2015 Still not good enough!

35 FY 2017 Pressure Injury Reduction Initiatives Skin Champions Electronic Braden Report

36 Skin Champions Front line defense for prevention Empowerment!

37 Electronic Braden Report Weekly Long-Term Care Reports Daily Specialty Hospital Reports Highlights patients at risk leading to re-evaluation Electronic report is disseminated to leaders Nurse Unit Room Number Patient Full Name Fin Num First Braden Score Last Braden Score Braden Up to Date? Date of Last Score Difference List of Orders with Details

38 FY 2017 Results 38 Injuries House-Wide 80% reduction from FY % reduction from FY 2016 We continue to improve

39 FY 2018 Pressure Injury Reduction Initiatives Huddles Interdisciplinary Approach Heel Prevention dressings

40 Pressure Injury Reduction Huddles

41 Interdisciplinary Approach Enhance family and patient teaching about prevention Implement new evidence based practices Enhance nutritional consults Engage Clinical Practice Education Specialists Ongoing education through huddles Increase patient / resident mobility Involve wound surgeon in weekly wound rounds

42 Heel Prevention Dressings

43 FY 2018 Results 35 Injuries House-Wide 81% reduction from FY % reduction from FY 2017

44 FY 2019 Results 12 Injuries House-Wide (at the end of quarter 2) 87% reduction from FY 2013 (Q1 & Q2) 14% reduction from FY 2018 (Q1 & Q2)

45 Rate Number Pressure Injury Rates FY2014 Began Prevention Rounds Wound Documentation Sheet in HCS FY2015 Wound of the Week Cerner (EMR) Introduced Treatment Team Newsletter Nationwide Benchmarking with Prevalence study FY2016 Braden Score Reports Skills Day PUPP Day New Employee Orientation Preventative Dressings FY2017 Involved Nursing and Frontline Staff to Skin Management Meetings Created Skin Champions Created electronic Braden Report FY2018 Improved Prevention Rounds Nutrition Follows HICU Patients Hired New Wound Doctor Heel Prevention Dressings Huddles Number Rate Trend

46 Use Evidence Based Practices Promote Staff Engagement Provide One to One education Encourage Wound Care Certification

47 One Pressure Injury is too many. Do everything you can do to prevent a wound.

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50 For Questions, Contact. Barbara Quinn RN, BSN, CWON, WCC Wound Care Manager Marian Chima MSN, RN, CDE VP of Patient Care Services & CNO Leigh Smith RN, MSN Director of Quality & Patient Safety

51 Acknowledgements Leigh Smith, RN, MSN Susan Johnston, BSN, CIC Sherise Brogden RN, BSN Director of Quality and Patient Safety Director of Infection Prevention Clinical Practice Education Specialist Cassaundra Jirau, RN, BSN Quality and Patient Safety Specialist Atinuke Awosika, RN, MSN Quality and Patient Safety Specialist Damion Jenkins, RN, MSN Clinical Practice Education Specialist Editor Shanae McLean RN, MSN, MBA Director of Nursing Long Term Care/Subacute