Impact of pressure injury education for nurses on hospital pressure injury prevalence rates Kimberly Bock Hanson, BSN, RN, CWON Gina Jansen, BSN, RN, CWOCN
Purpose» To describe the background and implementation of SHIELD rounds» To assess staff nurses perceptions of how SHIELD rounds have effected pressure injury prevention self-efficacy and patient outcomes» To evaluate the effect of SHIELD rounds on hospital pressure injury prevalence rates
Aims and Objectives of SHIELD» Aims ~ To build a culture of nurse empowerment and self-efficacy ~ To improve patient outcomes» Objectives ~ Rounding by WOC nurses on nursing units monthly (except for PUPS) Product in-services Prevention techniques and rationales Promoting resources to support interventions
Introduction and Background» Pressure Ulcer/Injury ~ Centers for Medicare & Medicaid Services (CMS) ~ California Department of Public Health (CDPH) ~ Risks to hospitals and patients» Pressure Ulcer Prevalence (PUPS) % of Patients with Hospital Acquired Pressure Injuries % of Patients with HAPIs 2.5 2 1.5 1 0.5 0 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 Total Facility CALNOC Benchmark
The Magnet Model»Transformational Leadership ~ Empowering evidence based practice, removing barriers»structural Empowerment ~ An environment of professional engagement and professional development»exemplary Professional Practice ~ Empowerment of nursing practice through education ~ Integrating quality indicators»new Knowledge and Innovation ~ Engage in research, presentations
SHIELD: Skin Health Improvement through Evidence, Learning, and Development
Developing SHIELD Rounds» RN & WOCN feedback ~ PI staging ~ Identifying pressure injury versus other wounds ~ Differentiating MASD and PI ~ PI interventions ~ Device-related PI» Multiple approaches to education
Providing SHIELD Rounds» Wound Care Nurses ~ Hospital skin care experts ~ Limited reach» Skin Care Champions ~ Unit skin care experts ~ Unbounded time, access
SHIELD Timeline CNO requires education rounds WOCNs survey for educational needs. 1 st SHIELD Rounds conducted. Day shift & Medical Center only. 7 th Floor SCC present SHIELD Rounds. Night shift, East Campus and Surgical Hospital included. 6 th Floor & 8300 SCC present SHIELD Rounds. 1 year of SHIELD Rounds completed. East Campus SCC present SHIELD Rounds. East Campus SCC present SHIELD Rounds. Jul. 2016 Aug. Oct. Apr. 2017 Jul. Oct. Dec. Re-evaluation Growth Growth Growth Growth Implementation Continuity and Reiteration
SHIELD Rounds Impact 2.5 800 % of Patients 2 1.5 1 0.5 700 600 500 400 300 200 100 Bedside R N Participation 0 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017 Q4 2017 % of Patients with Hospital Acquired Pressure Injuries Bedside RN Participation in SHIELD 0
SHIELD Evaluation» Survey: January 2017» Question 1: Have you participated in SHIELD Rounds» Question 2: If you ve participated in SHIELD Rounds, would you recommend it to a coworker?» Question 3: Has participating in SHIELD Rounds improved your ability to customize pressure injury prevention? Question 1 65.60% 97.22% Question 2 91.67% Question 3 16.97% 17.43% 2.78% 8.33% Yes No, never heard of it No, but I heard my coworkers talking about it Yes No Yes No
SHIELD Evaluation» Survey: April 2018» Question 1: Have you participated in SHIELD Rounds?» Question 2: How much has participating in SHIELD Rounds improved your ability to customize pressure injury prevention for your patients? 80.65% Question 1 Question 2 60.26% 30.77% 4.30% 15.05% 8.97% Yes No, what are SHIELD Rounds? No, but I heard my coworkers talking about it Has not helped Has helped some Has helped a lot
SHIELD Evaluation» Question 3: Has participating in SHIELD Rounds improved your confidence when staging pressure injuries?» Question 4: Has participating in SHIELD Rounds improved your ability to prevent device-related pressure injuries?» Question 5: Has participating in SHIELD Rounds improved your confidence in identifying moisture-associated skin damage (MASD)? Question 3 Question 4 Question 5 60.26% 70.27% 68.92% 40.00% 22.97% 25.68% 10.67% 6.76% 5.41% Has not helped Has helped some Has helped a lot Has not helped Has helped some Has helped a lot Has not helped Has helped some Has helped a lot
The Future of SHIELD» Yearly planning and evaluation» Skin Care Champions» Children s Hospital» Resurvey in 6-12 months
References Brindle, C. T., Creehan, S., Black, J. & Zimmermann, D. (2015). The VCU Pressure Ulcer Summit: Collaboration to operationalize hospital-acquired pressure ulcer prevention best practice recommendations. Journal of Wound Ostomy and Continence Nursing, 42(4): 331-337. doi: 10.1097/WO.0000000000000151. Jarman, H. J. (2009). Sharing expertise Using clinical rounds to improve UK emergency nursing practice. Australasian Emergency Nursing Journal, 12: 73-77. doi: 10.1016/j.aenj.2009.03.001. Kelleher, A. D., Moorer, A. & Makic, M. F. (2012). Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intensive care unit: A quality improvement project. Journal of Wound Ostomy and Continence Nursing, 39(2): 152-7. doi: 10.1097/WON.0b013e3182435409.