Prevention of Pressure Ulcers New York State Partnership for Patients October 22, 2012 New York, New York Evelyn S. Alcontin MA, ANP-BC,NP-C, CWOCN Mount Sinai Queens
Multiple Interventions Pressure Ulcer Risk Assessment Skin Assessment on Admission Hospital Stay, and Discharge Care Planning/Implementation of Care Patient/Family Education Staff Education Sustainability/Quality Improvement Efforts
Pressure Ulcer Risk Assessment Braden Scale Score (sensory perception, moisture,activity,mobility,nutrition,friction/shear) - on admission, weekly - change of status - Frequency increased to every 12 hours in the ER, ICU, Telemetry, Post-Anesthesia Care Unit, Respiratory Care Unit Include comorbidities/pt's status anemia, DM, hypotension, old age, s/p surgery, s/p code, and others
Skin Assessment On admission - Nursing Admission Data Base - Skin Assessment/Nursing Care Plan Hospital Stay - every shift: in Progress Note/Flow Sheet - Transfer to another unit: - Hand off sheet includes skin status Discharge : - Multidisciplinary Discharge Plan - Pilot Project: GOLD STAMP use of communication tool for pressure ulcer across health care settings
Individualized Care Planning/Implementation Skin Care cleanse, moisturize, protect evaluate skin care products: skin/wound care formulary Nutrition- Screen on admission- Referral to Dietary for at risk patients and with wounds - Nutritional supplements Support Surfaces: On admission - air mattress with heel relief (patients 300 lbs and below) rental: Clinitron, Total Care Sport Low Air Loss mattress with lateral rotation, Bariatric mattress purchase: ICU and Respiratory Care Unit -Total Care Sport Low air loss mattress with lateral rotation, Telemetry -Versa Care Air Mattress P500, Safety Rooms and Surgical Unit Versa Care Air
Offloading/Mobility 3 P's (Pain, Potty, Positioning) Heel protectors with pillow under legs Chair foam cushion Trapeze over bed Referral to PT/OT Purchase of air mattreses that can be transform to chair position
Patient/Family Education Skin Saver Brochure (by IPRO) English and Spanish versions Documentation in Patient Education Record by RN Learner, Method, Response Ask a Nurse Initiative
Staff Education Formal - mandatory class (coordinated by Staff Development) - wound care workshops - specialty beds/newly purchase beds - unit in-services : -proper use of skin care products - wound care models for white skin and dark skin assessment - revised forms for skin/wound assessment/care plan/wound monitoring
Staff Education Informal - nurses week: wound care booth - Q&A (staging, skin/wound care products, mattresses) raffle prizes - poster contest from each unit cash prizes for winners, Starbucks card - newsletter articles on skin/wound care - teaching/support at bedside
Sustainability/Quality Improvement Efforts Involvement of 2 unit RN and 1 Certified Nursing Assistant in conducting quarterly prevalence and incidence NDNQI class, chart review, flow sheet review, skin/wound assessment, feedback to unit - Wound Care Superstar! Pressure Ulcer rates visible in BEST Board - coordinates with QI Manager - cookies on the unit delivered by VP of Nursing/Director of Nursing Administrative support VP of nursing rounds with nursing assistant, supports pressure ulcer improvement projects
Comprehensive Programs for Preventing Pressures: A Review of the Literature Objective: To examine the evidence supporting the combined use of interventions to prevent pressure ulcers in the acute care and long-term care facilities Design: Systematic Review. 24 studies identified: incorporated more than 1 intervention, involved a multidisciplinary team, information on outcomes related to intervention Results: Decreased in prevalence and incidence rates Reference: Niederhouse, A., VanDeusen, C., Parker, V., Ayello, A., Zulkowski, K., Berlowitz, D. 2012. Comprehensive programs for preventing pressure ulcers: A review of the literature. Advances in skin and wound Care: The international journal for prevention and healing.vol. 25, number 4, April 2012, pp. 167-188.
Pressure Ulcer Tool Kit The literature review was performed as part of developing a process to develop a tool kit to reduce pressure ulcer using a multifacated quality improvement approach. FREE tool kit available on the Agency for Healthcare Research and Quality Website: http://www.ahrq.gov/research/ltc/pressureulcertoolkit/
Practice Pearls The review of the literature supports multidisciplinary, bundled approaches to pressure ulcer prevention No one approach has been identified as being best; institutions should carefully plan and customize pressure ulcer prevention programs according to their needs and abilities (Niederhause, et al. 2012. Comprehensive programs for preventing pressure ulcers: A review of the literature. Advances in Skin and Wound Care, volume 25, issue number 4, April 2012, 167-190)
Practice Pearls Pressure Ulcer prevention programs require attention to content as well as implementation and sustainability strategies Institutions having implemented pressure ulcer programs are encouraged to share their strategies and results so that others can learn from the experience (Niederhause, et al. 2012. Comprehensive programs for preventing pressure ulcers: A review of the literature. Advances in Skin and Wound Care, volume 25, issue number 4, April 2012, 167-190)
Thank You!