Establishing a Conservative Approach to the Prevention of Pressure Ulcers with the Utilization of Data Analytics to Monitor Effectiveness of Quality Efforts and Best Practice Models Tina Nelson, MBA, BSN Lisa Stepp, BSN, RN Rebecca Fyffe, BSN, RN Jessica Coughenour, LPN
OBJECTIVES Define best practices for assessment and documentation for prevention of pressure ulcers Identifying best practices: Understanding risk factors Review of current status Need for standardization of best practices Nursing communication
THE PROBLEM Pressure ulcers not only impose financial strain on a healthcare organization because of greater consumption of healthcare resources, they place patients at risk for infection, increased pain and lengthy care management requirements in both inpatient and outpatient settings. At Holzer, there were no current best practice standards and workflows to inhibit and prevent pressure ulcers for patients at risk during their inpatient hospitalization.
OUR PROJECT Reconditioning current practice into standardized best practice behaviors required a retrospective review of the current state against ideal state clinical models. A Quality Team Meeting (QTM) was initiated to redefine the processes for skin assessment upon admission, electronic capture of Braden Scale, nutritionist role, policy and procedures, and educational requirements. A Point of Impact (POI) was set to test the changes in the pressure ulcer prevention strategy. Projected outcomes without practice changes and the results post implementation were reviewed with the utilization of statistical software. Data analytics were deemed to be acceptable for monitoring outcomes by the QTM.
METHODOLOGY In-depth individual case analyses were performed by the QTM which identified inconsistencies in Braden Scale classification/rank and anatomical documentation. A new skin assessment protocol was implemented requiring two licensed nurses for all admissions and transfers including anatomical documentation completed on a body diagram, agreed upon by both nurses. An algorithm was developed following review of best practice models and interventions were assigned to each risk group. A policy was created reflecting the two nurse skin assessment protocol and corresponding best-practice interventions for each risk group. SBAR forms were updated to include specific pressure ulcer details to improve nursing communication and continuity of care.
SKIN ASSESSMENT ALGORITHM
Forecasted Trends FORCASTED TRENDS AND PROJECTIONS WITHOUT PROCESS CHANGE
HAPU per 1000 IP Admits HAPU per 1000 IP Admits POST ANALYSIS: POINT OF IMPACT TREND 2W HAPU per 1000 Inpatient Admissions 4th Floor HAPU per 1000 Inpatient Admissions 20 20 15 15 10 10 5 5 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Threshold Target HAPU per 1000 IP Admissions Point of Impact Threshold Target HAPU per 1000 IP Admissions Point of Impact
HAPU per 1000 IP Admits HAPU per 1000 IP Admits POST ANALYSIS: POINT OF IMPACT TREND, cont d CCU-Gallipolis HAPU per 1000 Inpatient Admissions Rehab HAPU per 1000 Inpatient Admissions 20 50 15 40 30 10 20 5 10 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Threshold Target HAPU per 1000 IP Admissions Point of Impact Threshold Target HAPU per 1000 IP Admissions Point of Impact
HAPU per 1000 IP Admits POST ANALYSIS: POINT OF IMPACT TREND TOTAL HAPU HOSPITAL RATE Total HAPU per 1000 Inpatient Admissions 8 6 4 2 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Threshold Target HAPU per 1000 IP Admissions Point of Impact
CONCLUSIONS Retrospective data analysis established baseline averages for our population against which future interventions may be measured. The monthly data collection was a means of validating averages in the inpatient setting and working toward the development of pressure ulcer prevention program (PUP). As results are produced, surveillance activities continue to monitor the effectiveness of the performance improvement project.