Ann Klein, Wound Care Specialist Brenda Mundy, Manager, Skin and Wound Program Innovative Strategies lead to a Reduction in Pressure Ulcer Incidence
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
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
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. 2012 Completion of Braden Risk Assessment within 24 hours of admission 65% Pressure ulcer incidence monitoring added to the Quality Improvement Plan Indicators (QIP)
Current State 13-14 Fiscal Year Pressure Ulcer incidence rate =5.2% Incidence Aug 2014-7% Heel ulcers for patients wearing boots-0% Completion of Braden score within 24 hours of admission- 85%-sustained for greater than 1 year
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
Braden Score Assessment-Sharing the Information- 13-14 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
Direct care provider leadership=sustained results Cardiac Unit 13-14 100% 80% SRHC average 60% 40% Monthly average 20% 0% Apr Jun Aug Oct Dec Feb
Heelboots Criteria for Use: Patients age 75and older with a diagnosis of Fractured hip Total hip replacement Stroke OR Nursing Clinical Judgment!
Education and Staging Certification One day education Unit to Unit education Job Shadowing Staging Certification 10-15 minutes focused education Available online Available for Students Save our Skin
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
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
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
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 13-14 5.2% Incidence Aug 2014-7% Heel ulcers for patients wearing boots-0% Completion of Braden score within 24 hours of admission-87% Outcomes
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
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
Thank you Ann Klein RN BScN CETN(C)aklein@southlakeregional.org Brenda Mundy RPN, RN, BScN bmundy@southlakeregional.org