Enhancing SAFE SKIN Through Computer Utilization OhioHealth s Mission: To Improve the Health of Those We Serve 2 1
3 Grant Medical Center 21,000 patient discharges/year Average daily census of 260 Magnet Designated Fortune Top 100 Places to Work Level 1 Trauma Center JCAHO disease specific certification in Stroke, Joints, and CHF US News & World Report Top 100 4 2
Session Objectives Identify and utilize preexisting coded patient data to promote understanding PU population. Integrate and apply system data to facilitate quick identification and response to high risk skin patients. 5 Initial Interventions Announcement of CMS Never Events 2008 Staff education through poster event 2008 NDNQI CEU Program Established Core Skin Work Team Focus of documentation of pre-exisiting conditions Standardize Speciality Bed Usage Initiated Safe Skin Care Champions 2009 National Speaker Event 6 3
Just the Growing Facts 2007 GMC cared for 298 patients with Pressure Ulcers 2008 GMC cared for 375 patients with Pressures Ulcers 2009 GMC cared for 354 (472) patients with Pressure Ulcers 7 High Risk Indicators Nutritional Status Previous History of a Pressure Ulcer Elongated Length of Stays Compliance with Turning Schedules on High Risk Patients 8 4
Nutritional Status Considerations Establish direct reports to dietitians from lab via Midas Automating immediate nutritional consults based on lab Tracking information on one daily report Albumin <=3 or Pre-Albumin <=20 are risk factors for skin breakdown 9 Earlier Prevention through Nutritional Status Alerts 10 5
Patients With Extended LOS Automatic Wound Care consults Patients with LOS greater than 14 days Access as a daily report Track Length of Stays for high risk population of patients 11 Alerts for Extended LOS patients 12 6
Previous or Healing Pressure Ulcers Automatic consults to Wound Care Nurses Promotes quicker response to patient needs and clearer picture of healing pressure ulcer Pulls discharged coded patient s data from all central OhioHealth system hospitals and matches with new admissions to Grant Captures 1 rolling year 13 Alerts for Previous Pressure Ulcers 14 7
Discharged Patient Alerts Based on coded data available in Midas Alert issued immediately and populated on work list available in Midas Immediate E-mail notification of hospital acquired pressure ulcer (stage 3 and 4) to outcomes manager Review of the chart for verification of hospital acquired pressure ulcer 15 Discharged Patient Alerts 16 8
Focus Study 17 OHIO PUBLIC REPORTING 18 9
TURN! TURN! TURN! 19 Daily Monitoring for Inpatients Quick Audits for high risk patients on each unit 24 hour picture of Skin Integrity care Targeted Braden s of 18 or less Turning documentation by both RN and PSA in Horizon Expert Documentation Documentation of pressure ulcer on skin assessments Identification of documenting nurse Facilitate daily rounding on high risk patients 20 10
Mobius Reports 21 Overall Monthly Incidence Reports Lists all patients cared for each month with a pressure ulcer Identifies present on admission and non present on admission pressure ulcers Identifies completed Wound Care Team Consults from HED documentation Chart review of each hospital acquired pressure ulcer required to assign unit of origin Quick visual of patients hospital stay and where breakdown occurred 22 11
Monthly Incidence Report 23 Monthly Analysis by Unit 24 12
To help protect your privacy, PowerPoint prevented this external picture from being automatically downloaded. To download and display this picture, click Options in the Message Bar, and then click Enable external content. 2/2/2010 Analysis of Present on Admission Pressure Ulcers 25 SCORE! COLUMBUS BLUE JACKETS COLUMBUS CREW 26 13
Grant Scores 27 Incidence Rates for Scorecards Provides monthly hospital acquired incidence rates based on coded data for population of scorecard Provides more timely feedback to managers Based on 1000 patient days Based on chart review of all hospital acquired pressure ulcers 28 14
Incidence Reporting 29 Population of Nursing Scorecard 30 15
Overview Of All Pressure Ulcers 31 OUTCOMES Grant Medical Center Hospital Acquired Pressure Ulcers 6 5 4 3 2 1 0 Oct-08 Nov-08 Dec-08 #Pressure Ulcers Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Hospital Acquired - Stage I/II Hospital Acquired - Stage I/II - Trendline Hospital Acquired - Stage III/IV Hospital Acquired - Stage III/IV - Trendline 32 16
PRESSURE ULCER STAGES 60% 50% 40% 30% 20% 10% 0% 52% Percent of Pressure Ulcers 26% 6% 10% I II III IV Unable to Stage / Eschar 4% 2% Deep Tissue Injury 33 PRESSURE ULCER PREVALENCE TRENDING PATIENTS WITH FACILITY-ACQUIRED WOUNDS 14% 12% 10% 8% 6% 4% 2% 0% Percent of Patients 5.1% 6.9% 10.1% 9.7% 6.3% 2.5% 11.4% 6.7% 4.4% 4.2% 3.8% 1.2% 3.3% 4.0% 4.1% 6.2% 3.1% 3.2% 5.3% 6.2% 4.5% 0.4% 7.0% 3.3% 2.8% 3.3% 2.3% 1.2% 2.9% 2.7% 3.3% 3.1% Including Stage 1 Excluding Stage 1 Sep-98 Oct-99 Oct-00 Sep-01 Oct-02 Oct-03 Sep-05 Oct-06 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Jun-09 Aug-09 34 17
Summary of Automating Data Saves time Improves responsiveness to patient care needs Provides mangers with organized data Automates patient care consults Alerts staff to high risk patients Timely feedback on monthly incidence Immediate education opportunities Immediate corrections in patient care 35 Columbus, Ohio Contact Information Tonya Motsinger RN BSN MBA Quality Outcomes Manager 614-566 9123 tmotsin2@ohiohealth.com Patty Lowe, RN, BSN, MBA,NE- bc Director Centralized Nursing Services Patient Logistics Communication Center Grant Wound Care and Hyperbarics Center Grant Arthritis Infusion Center System Administrator - Aionex 614 566 9120 plowe@ohiohealth.com 36 18
Thank you 19