Ann Klein, Wound Care Specialist Brenda Mundy, Manager, Skin and Wound Program. Innovative Strategies lead to a Reduction in Pressure Ulcer Incidence

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1 Ann Klein, Wound Care Specialist Brenda Mundy, Manager, Skin and Wound Program Innovative Strategies lead to a Reduction in Pressure Ulcer Incidence

2 Background Outline Innovative strategies to develop point of care leadership and accountability Monthly auditing of Braden risk assessments within 24 hours of admission to acute care Pressure relieving heelboots Education and Staging Certification Quarterly Bedside Prevalence and Incidence Incident reporting of new pressure ulcers Program Webpage Next steps in our journey

3 About Us A part of the community since the 1920 s Located in Newmarket, Ontario, just north of Toronto 400+bed acute care facility 8 Regional Programs Cardiac Care Cancer Care Child and Adolescent Eating Disorders Child and Adolescent MH Paediatric and Perinatal Care Thoracic Surgery Cataract Surgery Arthritis Care 19 inpatient units Almost 1400 nurses

4 Background In June 2012, the annual pressure ulcer prevalence and incidence study reported a 20% incidence of pressure ulcers at Southlake Regional Health Centre, including a 50% rate for patients in the Intensive Care Unit Completion of Braden Risk Assessment within 24 hours of admission 65% Pressure ulcer incidence monitoring added to the Quality Improvement Plan Indicators (QIP)

5 Current State Fiscal Year Pressure Ulcer incidence rate =5.2% Incidence Aug % Heel ulcers for patients wearing boots-0% Completion of Braden score within 24 hours of admission- 85%-sustained for greater than 1 year

6 Braden Score Completion Auditing A measure that could be taken directly from the electronic record Monthly results demonstrate Number of admits to acute care beds Number of admits with completed Braden Scores Completion by % Provides real time feedback

7 Braden Score Assessment-Sharing the Information Medicine unit example 100% 80% 60% 40% SRHC average Unit X 20% 0% Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

8 Direct care provider leadership=sustained results Cardiac Unit % 80% SRHC average 60% 40% Monthly average 20% 0% Apr Jun Aug Oct Dec Feb

9 Heelboots Criteria for Use: Patients age 75and older with a diagnosis of Fractured hip Total hip replacement Stroke OR Nursing Clinical Judgment!

10 Education and Staging Certification One day education Unit to Unit education Job Shadowing Staging Certification minutes focused education Available online Available for Students Save our Skin

11 Bedside Prevalence and Incidence Studies No reliable benchmarks need to create own Develop and implement targeted strategies to reduce pressure ulcers Completed as part of the daily nursing assessment Yearly studies are not adequate-quarterly required for QIP Annual P and I studies expensive ($9000 each) Building direct care capacity and accountability

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14 Benefits Bedside Prevalence Reporting Involves all nurses in the prevalence study Data turn around within 2 days Highlights practice concerns Real time/targeted education Dispels long held beliefs Cost effective Increased confidence in assessment/management Annual Prevalence and Incidence study conducted to validate quarterly results

15 Webpage available on the SRHC intranet Contains: All prevalence and incidence reports Staging certification power point How to rent a specialty surface Clinical orientation to Skin and Wound Program Helpful resources

16 Education-Accountability-Outcomes Pressure ulcer staging certification Orientation Braden Score Education Basic Wound Care level 1 Nursing council education Tools available electronically Heelboots Education Accountability Braden Score Audits Quarterly bedside prevalence reporting Results posted on webpage Pressure Ulcer prevention and management SOC Incidence % Incidence Aug % Heel ulcers for patients wearing boots-0% Completion of Braden score within 24 hours of admission-87% Outcomes

17 Next Steps Bed and Mattress audit and replacement plan Standardized order sets for uncomplicated Pressure Ulcers Additional Education Days Pressure Ulcer of the Month on wound care website Referrals to the Wound Care Specialist Targeted Education Documentation RFID specialty surfaces

18 The last word goes to Florence Poisoning by the skin is no less certain than poisoning by the mouth-only it is slow in its operation

19 Thank you Ann Klein RN BScN Brenda Mundy RPN, RN, BScN