2018 Hill-Rom International Pressure Ulcer/Injury Prevalence Survey Survey Booklet

Transcription

1 2018 Hill-Rom International Pressure Ulcer/Injury Prevalence Survey Survey Booklet

2 2018 Hill-Rom IPUP Survey Dear Survey Participant: Thank you for participating in the 2018 Hill-Rom International Pressure Ulcer/Injury Prevalence Survey. This will mark our 22nd National Prevalence Survey and 16th International Prevalence Survey. We appreciate you taking part in this exciting event. We have compiled this Survey Booklet of information and helpful hints to assist you with planning, coordinating, and completing the survey. Included in this participant booklet: Organize the Survey 3 Resource Estimation 4 Survey Announcement Poster 5 Sample Meeting Agenda 6 Survey Supplies, Unit List and Surface List 7 Data Collection Form 8 NDNQI 9 Completing the Form 10 Delivery of Survey Supplies / Return of Forms 11 Return Instructions 12 Guidelines for Staging of Pressure Injuries 13 Braden Risk Assessment 14 Important dates to remember: The survey must be done within one 24-hour period between February 20-22, 2018 and the return envelope/ box (using the pre-paid label) postmarked by March 2, We appreciate your cooperation as these dates are necessary to ensure the integrity of the results. Results of the survey will be available in late Spring Each facility will receive an electronic presentation of individual results and national benchmarking. Please feel free to contact your local Hill-Rom representative at (800) , call the Hill-Rom International Prevalence Hotline at (888) , or informationprogramteam@hill-rom.com with any questions. Thank you again for participating in the survey!

3 Organize the Survey What is a Prevalence Survey? A pressure ulcer/injury prevalence survey includes examining ALL patients in your facility (in participating units). You will fill in one data collection form for EACH patient, noting whether or not the patient has a pressure ulcer/injury. Do NOT include patients who refuse, were discharged or who are out of the room. Organize the Survey All of the information needed to organize your teams is included in this document. We suggest that you create team packets from the shipped materials that come with the Scantron forms to distribute to the data collectors. The number of team packets included in your box of supplies was determined using your expected survey census. If you need additional packets, feel free photocopy any items, excluding the Scantron forms. Review how many teams and data collectors you will need for your survey. Refer to the Resource Estimation available in this booklet (page 4). We have found that utilizing nursing students to conduct prevalence surveys provides a two-fold benefit: enhancing student education and providing resources for the survey. Designate a team leader for each of your teams. This person can help you by taking the responsibility for talking to the unit coordinator upon entering the unit, ensuring all patients are assessed, verifying forms are complete, and reporting back to you with the completed data collection forms. Fill in the Survey Announcement Poster (page 5) and post it in participating units. Send reminders to all participating data collectors a few days prior to the survey. Communicate the location and time they should meet to begin the survey. Provide advance notice to all units concerning the survey. Send unit coordinators a memo detailing the survey and list what the unit may do to help make the survey easier on all parties (ex. dressing changes, provide a copy of the census sheet). Plan a meeting with all data collectors just prior to the data collection. You may use the agenda (page 6) provided in this document to assist you. Discuss which questions on the form are to be completed. If the question is not applicable, not relevant, or not of interest to your facility, please leave it blank. Discuss guidelines for correctly completing the form. 3

4 Resource Estimation This table will help you estimate the number of teams required for completion of the survey in an 8-hour shift. Teams should consist of a minimum of 2 members per 33 patients. One team member documents the data on the form while the other team member(s) inspect the patients and complete the chart review.* Number of Patients Number of Teams Number of Data Collectors *Based on internal Hill-Rom time and motion studies. 4

5 Survey Announcement Poster Attention Staff Members The Hill-Rom International Pressure Ulcer/Injury Prevalence Survey will be conducted on (Date) If you have any questions, please contact (Name) (Phone Number) Thank you for your support.

6 2018 Hill-Rom International Pressure Ulcer/Injury Survey Agenda Type of meeting: Facilitator: Attendees: Agenda Assign data collectors to teams and announce team leaders. Set expectations of the team leaders responsibility. Assign each team to their specific unit(s) and decide on a designated meeting area at the completion of their units. Distribute data collection forms, discuss which questions are being collected and review question instructions. Remind collectors that only #2 pencils can be used and Scantron forms cannot be photocopied for data collection. Discuss the Unit Code List and how to code the form correctly. Review NDNQI data collection questions and guidelines if applicable. Review the Braden scale card or discuss your own facility s risk scale. Review the Surface Code List or distribute a shortened version of your facility s surfaces. Review the staging guidelines and facility wound documentation protocols. Identify protocols for dressing changes, empty beds, and patient refusals. Provide your beeper/pager number to the team members. 6

7 Survey Supplies, Unit List and Surface List Survey Supplies The box of survey supplies that you receive includes: Pre-printed Scantron data collection forms Scantron data collection form instructions Quick Tips Unit List Surface List Pre-Paid Fed Ex Return Mailing Label Fed Ex Ground label Pencils, Braden Risk/Guidelines for Staging of Pressure Injuries laminated card Return envelope Open your box of supplies as soon as you receive it and familiarize yourself with the contents. Contact the Hill-Rom IPUP Hotline at ( ) if you have any questions or concerns about the contents. If you have multiple facilities (or market segments) participating that have registered separately for the survey (and have received separate survey ID codes), you will receive a separate box of supplies for each. Please note that the unique facility name and unique survey ID code is printed on the forms. Do not mix forms between participating facilities (market segments)! Mixed forms will result in mixed results. Unit List Review the Unit List that will be mailed to you with your survey supplies. If any changes to your Unit List are needed, please call the Hill-Rom IPUP Hotline at (888) You may make changes to your Unit List with Hill-Rom at any time up until the survey and an updated Unit List can be ed to you for your use. Surface List Review the Surface List mailed to you with your survey supplies. It might be helpful, prior to the survey, to identify the surface codes you ll need for your own facility and then create a smaller cheat sheet of surface codes for your data collectors. On the day of the survey, during the team meeting, review the list of surface codes to be used. Hill-Rom Surfaces are listed on page 1, Other Surfaces are listed on pages 1 and 2, and Generic Surfaces are listed at the bottom of page 2. If you do not find your surface listed specifically by name, please select a surface from the Generic Surfaces section at the bottom of page 2. Generic Surfaces: 390 Other Air Fluidized 392 Other Bariatric Low Air Loss (LAL) 371 Other Gel 224 Other Mattress Foam 478 Other Mattress Low Air Loss (LAL) 229 Other Mattress Overlay Low Air Loss (LAL) 225 Other Mattress Overlay Non-Powered 230 Other Mattress Overlay Powered 468 Other Mattress Pressure Redistribution 226 Other Mattress Replacement Non-Powered 227 Other Mattress Replacement Powered 228 Other Mattress Waffle 403 Stretcher Surface When identifying the surface, be sure to choose the surface that is closest to the patient s skin. 7

8 Data Collection Form Review the data collection form. Scantron data collection form instructions are included in your survey supplies and also in the Data Collection Form Training. Divide your data collection forms by unit using the average unit census to estimate how many each unit will need. You may want to paper clip the forms together and label them with the unit number and team leader s name. Note that higher acuity patients will take additional time and fewer units should be assigned to teams responsible for these types of units. When completing the data collection form: Be sure to mark the correct bubble using a #2 pencil: If the question is not applicable, not relevant, or not of interest, please leave it blank. Fully erase any unnecessary markings on the data collection form. Any blank bubbles for a field will be reported as Unspecified/Not Collected data. Any unassigned unit codes will be reported as Unspecified/Not Collected. (An Unassigned unit code is any unit code not previously assigned and communicated to you by Hill-Rom.) Do not use survey forms left over from a prior survey. Each prevalence survey has a unique 5 digit survey ID code printed on the form which is directly tied to that particular survey. If forms from a prior survey are used, the data recorded on those forms will follow the unique survey ID for the prior survey and the data will be added to that prior survey. Double check all your data collection forms before mailing them back to Hill-Rom for processing. The accuracy of your results is based on the accuracy of your forms. Questions to consider: Were only #2 pencils used on the forms? Were unit codes bubbled on each form? Is there only one pressure ulcer/injury marked in each wound column? Is each pressure ulcer/injury staged and documented? Is all the required information complete on each form? Are there any unnecessary markings on the data collection forms that should be erased? Scantron forms cannot be photocopied for data collection. Originals must be ordered from Hill-Rom. IMPORTANT: Make copies of your completed data collection forms to keep for your records before returning the forms to Hill-Rom. 8

9 NDNQI National Database of Nursing Quality Indicators In order to fulfill NDNQI (National Database of Nursing Quality Indicators) data collection requirements for Pressure Ulcer/ Injury Prevalence, please complete the questions colored in orange on the IPUP data collection form. NDNQI identifies pressure ulcer/ injury prevalence and restraint prevalence as separate quality indicators. If your facility collects restraint data to submit to NDNQI, please complete questions If your facility does not submit restraint data to NDNQI and is not interested in collecting restraints, please skip questions and leave them blank. The Hill-Rom IPUP Survey satisfies the requirements for NDNQI first quarter Pressure Ulcer/Injury Prevalence. A spreadsheet of results will be ed to you which you can then input on NDNQI s website prior to the NDNQI first quarter deadline of May 15th. Q# Question Wording 1 Unit 2 Age (Years or Months or Days or Weeks) 3 Sex 20 Skin Assess Documented w/in 24 hrs of Admit 21 PI Risk Assess Documented w/in 24 hrs of Admit 22 Admit Risk Methodology 23 Admit Risk Score 24 Last/Current Risk Methodology 25 Last/Current Risk Score 26 Documentation of Last Risk Assessment 27 Patient At Risk for Pressure Injuries 28 Pressure Injury Prevention in Use Last 24 hrs for At Risk Patient 29 Skin Assessment Documented w/in past 24 hrs 30 Pressure Redistribution Surface in Use w/in past 24 hrs 31 Routine Repositioning as Prescribed w/in past 24 hrs 32 Nutritional Support w/in past 24 hrs 33 Moisture Management w/in past 24 hrs 34 Restraints in Use 35 Restraint Type 36 Restraint Category 37 Justification for Restraint 45 Does this Patient have a Pressure Injury? 46 Pressure Injury Detail: Location, Stage, Present on Admission to Facility, Present on Arrival to Unit 47 PI Device Related 9

10 Completing the Form When completing the data collection form be sure to mark the correct bubble using a #2 pencil. An example of the proper mark is shown below. If the question is not applicable, not relevant, or not of interest, please leave it blank. Fully erase any unnecessary markings on the data collection form. Any blank bubbles for a field will be reported as Unspecified/Not Collected. Any unassigned unit codes will be reported as Unspecified/Not Collected. (An Unassigned unit code is any unit code not previously assigned and communicated to you by Hill-Rom.) DO NOT DO NOT make markings ( x s, slashes, hand written words, etc) on the data collection form. DO NOT mark X s across unanswered questions. DO NOT fold, tear or bend the form. DO NOT attach stickers on the front or back of the form. DO NOT use permanent marker or pen. Scantron forms cannot be photocopied for data collection. Scantron forms from a prior survey cannot be used. If you need additional forms, please contact the Hill-Rom International Prevalence Hotline at and additional forms will be sent to you. DO NOT staple or hole punch the forms. DO NOT use Scantron data collection forms from a prior survey. 10

11 Delivery of Survey Supplies & Return of Forms Delivery of Supplies Hill-Rom will send your survey supplies in a cardboard box or envelope marked with a Hill-Rom IPUP sticker via FedEx Ground delivery. For delivery of your supplies, please check with your facility mail room (shipping/ receiving), or with the location in your facility that receives FedEx deliveries. Hill-Rom will you tracking for the delivery of the package. If after checking internally, the box of supplies cannot be located in your facility, please call the Hill-Rom IPUP Hotline ( ). Open your box of supplies as soon as you receive it and familiarize yourself with the contents. Contact the Hill-Rom IPUP Hotline at ( ) if you have any questions or concerns about the contents. If you have multiple facilities (or market segments) participating that have registered separately for the survey (and have received separate survey ID codes), you will receive a separate box of supplies for each. Please note that the unique facility name and unique survey ID code is printed on the forms. Do not mix forms between participating facilities (market segments)! Mixed forms will result in mixed results. Scantron forms cannot be photocopied for data collection. Scantron forms from a prior survey cannot be used. Return Completed Forms For the return of your completed forms, please check with your facility mail room (shipping / receiving) to see if FedEx regularly drops offs and picks up there. If they do, leave your return envelope (or box) affixed with the prepaid FedEx ground label in this department for pick up by FedEx. If FedEx does not regularly come by your facility for drops offs and pick ups, then please call FedEx to schedule a pick up. Call Go-FedEx When the automated attendant begins to speak say, Schedule a pick up. (You may have to say it more than once, and very clearly.) You will be asked what your FedEx account number is. Say, Customer Service. You will then be transferred to a Customer Service Representative. Explain that you would like to schedule a pick up for a package with a preprinted, pre-paid return label. Please note: FedEx may ask you for an account number in order to schedule a pick up. You do NOT need an account number because your return uses a Hill-Rom supplied, pre-printed, pre-paid return label and all the necessary information is included on the label. Additional return options include: Dropping the package by a FedEx pickup location, or You may choose to send your forms back using the carrier of your choice (US Postal service, etc). However, in this case, you will assume the obligation to pay for the return postage. We also strongly suggest you retain copies of your forms and purchase tracking for the package. Do NOT put your return box/envelope in a FedEx drop box! 11

12 Return Instructions Return your completed data collection forms using your box or the white return envelope provided and the postage-paid mailing label (picture below). REMEMBER: All completed survey forms must be sent back to Hill-Rom postmarked by March 2, DO DO check forms to make sure all bubbles are filled in (especially unit codes). DO make photo copies of your completed forms to keep for your records. DO call FedEx at Go FedEx to schedule a pick up for your package. (Refer to the Delivery of Survey Supplies and Return of Forms section in this booklet.) DO NOT DO NOT send back blank data collection forms or forms for patients who refused, were discharged or were out of the room. Postage-paid mailing label DO NOT put your return box/ envelope in a FedEx drop box! Drop boxes are for overnight packages only and your Ground delivery package will not be returned to Hill-Rom. 12

13 Guidelines for Staging of Pressure Injuries Your survey supplies will include laminated Guidelines for Staging of Pressure Injuries as pictured to the right. The following criteria can be used as a visual aid to help identify and appropriately stage pressure ulcers/injuries. The definitions were derived from work done by the National Pressure Ulcer Advisory Panel in Guidelines for Staging of Pressure Injuries* *National Pressure Ulcer Advisory Panel (NPUAP) Accessed April Stage 1 Stage 1 with Edema Stage 2 Stage 3 Stage 3 with Epibole Stage 4 DTI Unstageable with Dark Eschar Unstageable with Slough & Eschar PRESSURE INJURY A pressure injury is localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open injury and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue. STAGE 1 Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury. STAGE 2 Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. STAGE 3 Full-thickness loss of skin, in which adipose (fat) is visible in the injury and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. STAGE 4 Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the injury. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. DEEP TISSUE INJURY Intact or non-intact skin with localized area of persistent nonblanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. Images used with permission from UNSTAGEABLE Full-thickness skin and tissue loss in which the extent of tissue damage within the injury cannot be confirmed because it is obscured by slough or eschar. MEDICAL DEVICE RELATED PRESSURE INJURY This describes an etiology. Medical device related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes. The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system. MUCOSAL MEMBRANE PRESSURE INJURY Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue these injuries cannot be staged. WOUND ASSESSMENT CHECKLIST Location Stage Size Pressure Redistribution Dressing Used Nutritional Assessment Drainage (Amount/Color/Odor) Viable Tissue in Wound Undermining/Tunneling 13

14 Braden Risk Assessment Your survey supplies will include laminated Braden Scale cards as pictured below. NOTE: Bed and chair bound individuals with impaired ability to reposition themselves should be assessed for risk of developing pressure injuries. Patients with established pressure injuries should be reassessed periodically. Braden Scale for predicting pressure injury risk (Copyright Braden and Bergstrom, 1988) When eschar is present, a pressure injury cannot be accurately staged until the eschar is removed. Sensory Perception ability to respond meaningfully to pressure related discomfort Moisture degree to which skin is exposed to moisture Activity degree of physical activity Mobility ability to change and control body position Nutrition usual food intake pattern Friction and Shear 1. Completely limited: Unresponsive (does not moan, flinch or gasp) to painful stimuli, due to diminished level of consciousness or sedation, OR limited ability to feel pain over most of the body surface. 1. Constantly moist: Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned Hill-Rom Services, Inc. ALL RIGHTS RESERVED. CTG090rc rev AUG-2016 ENG US 2. Very limited: Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness OR has sensory impairment which limits the ability to feel pain or discomfort over 1/2 of body. 2. Very moist: Skin is often but not always moist. Linen must be changed at least once a shift. 1. Bedfast: Confined to bed. 2. Chairfast: Ability to walk severely limited or nonexistent. Cannot bear own weight and/or must be assisted into chair or wheelchair. 1. Completely immobile: Does not make even slight changes in body or extremity position without assistance. 1. Very poor: Never eats complete meal. Rarely eats more than 1/3 of any food offered. Eats 2 servings or less of protein (meat or dairy products) per day. Takes fluids poorly. Does not take liquid dietary supplement OR is NPO and/or maintained on clear fluids or IVs for more than 5 days. 1. Problem: Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. Spasticity contractures or agitation leads to almost constant friction. 2. Very limited: Makes occasional slight changes in body or extremity position but unable to make frequent or significant changes independently. 2. Probably inadequate: Rarely eats a complete meal and generally eats only about 1/2 of any food offered. Protein intake includes only 3 servings of meat or dairy products per day. Occasionally will take a dietary supplement, OR receives less than optimum amount of liquid diet or tube feeding. 2. Potential problem: Moves feebly or requires minimum assistance. During a move, skin probably slides to some extent against sheets, chair, restraints or other devices. Maintains relatively good position in chair or bed most of the time but occasionally slides down. 3. Slightly limited: Responds to verbal commands but cannot always communicate discomfort or need to be turned, OR has some sensory impairment which limits the ability to feel pain or discomfort in 1 or 2 extremities. 3. Occasionally moist: Skin is occasionally moist, requiring an extra linen approximately once a day. 3. Walks occasionally: Walks occasionally during the day but for very short distances, with or without assistance. Spends majority of each shift in bed or chair. 3. Slightly limited: Makes frequent though slight changes in body or extremity position independently. 3. Adequate: Eats over 1/2 of most meals. Eats a total of 4 servings of protein (meat, dairy products) each day. Occasionally will refuse a meal, but will usually take a supplement if offered, OR is on a tube feeding or TPN regimen, which probably meets most nutritional needs. 3. No apparent problem: Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair at all times. 4. No impairment: Responds to verbal commands. Has no sensory deficit which would limit ability to feel or voice pain or discomfort. 4. Rarely moist: Skin is usually dry; linen only requires changing at routine intervals. 4. Walks frequently: Walks outside the room at least twice a day and inside room at least once every 2 hours during waking hours. 4. No limitations: Makes major and frequent changes in position without assistance. 4. Excellent: Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of meat and dairy products. Occasionally eats between meals. Does not require supplementation. Note: Patients with a total score of 18 or less are considered to be at risk of developing pressure injuries. (19-23 = no risk, = low risk, = moderate risk, = high risk, < to 9 = very high risk) 14

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16 Hill-Rom is a leading global medical technology company with more than 10,000 employees worldwide. We partner with health care providers in more than 100 countries, across all care settings, by focusing on patient care solutions that improve clinical and economic outcomes in five core areas: Advancing Mobility, Wound Care and Prevention, Patient Monitoring and Diagnostics, Surgical Safety and Efficiency and Respiratory Health. Hill-Rom s people, products and programs work towards one mission: Every day, around the world, we enhance outcomes for patients and their caregivers. Hill-Rom reserves the right to make changes without notice in design, specifications and models. The only warranty Hill-Rom makes is the express written warranty extended on the sale or rental of its products Hill-Rom Services, Inc. ALL RIGHTS RESERVED rev 3 19-DEC-2017 ENG US For further information about this product or a service, please contact your local Hill-Rom representative or visit our webpage: USA Canada