Pressure Ulcer Prevention Project

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					Pressure Ulcer Prevention Project

             Special Hospital Project
        St. Luke Community Healthcare
            Katrina Strowbridge, RN
Pressure Ulcer Prevention Project
 One of three 3-year special projects to be
  implemented by MPQHF
 Pressure ulcers are one of “hospital
  acquired conditions”
 Area of patient harm that has proven
  responsive to systems of care
 Selected as a target facility – geographic
  zone
    FOR MORE INFO...
www.cms.hhs.gov/QualityImprovementOrgs/04_9thsow.asp#T
opofPage.
MPQHF Goal
 To assist facilities to improve system
  design through transformational
  change
 Incorporation of evidence based
  “best practices” into daily operations
  within organization and beyond to
  the next level of care
Project Description –
         What is expected of us?
 Complete contract agreement for August 2008 –
  July 2011
 Submit Medicare Part A claims forms with POA
  indicators for hospital acquired pressure ulcers
 Participate in educational sessions/offerings
 Maintain contact with project lead – Kirsten
  Kammerzell
 Share best practices and lessons with MPQHF
  and other participants
 Form interdisciplinary team to work on project
 Complete ROSC assessment
Project Description –
 What can we expect from MPQHF
   Support, resources, & consultation
    services
   Shared learning opportunities
   On site training and technical assistance
   Summary information on status of project,
    reminders, activity reports
   Sharing of information/stories Quality
    Review newsletter
   Provide facility recognition
Timeline
   September 2008 –
    – signed & submitted contract
   October 2008
    – Planning “how to start”
   November 2008 –
    – Round table with facilities
    – Conference call with Medline
    – Interdisciplinary team formed
       • William Cullis, MD; Leah Emerson, RN, DON; Donna
         McDaniel, RN, BSN,ADON; Katrina Strowbridge, RN,
         BSN, QIC; Diane Grogan, RD, Bruce McMillan, PT
Timeline continued
   December 2008 –
    – Site Visits
      • Hospitals
         – St. Joseph Medical Center
      • Home Health Agency
         – Home Options
      • Nursing Homes
         – St. Luke Community Healthcare
         – Mountain View Care Center
         – Evergreen Health & Rehabilitation
Timeline continued
   December 2008 –
    – Introductory Educational session PUP-
      EZ (Medline)
    – Pressure Ulcer Prevention Program
      (Medline)
    – Self Assessment (MPQHF)
   Mid December
    – “aha is part of transformation” right???
Timeline continued
     January 2009 –
      – Conference call participation MPQHF
      – PUP-EZ Pre tests out to staff
      – Calculation of Incidence & Prevalence
        Rates for Cost Tracker (Medline)
      – Foundation Employee Grant
        application submitted – Wound
        cameras
      – Policy & Procedure revision
Timeline continued
        February 2009
         – Policies/forms taken to Medical Staff
           (fork in the road)
         – PUP-EZ workbooks handed out
         – Introduction of products
         – Policies/forms revised further
         – Continued calculation of data
         – Grant awarded
            • Cameras ordered
Timeline continued
   March 2009 –                    Future actions –
    – PUP-EZ Post test               implementation,
    – Continued calculation          monitoring, moving to
      of data                        community level
    – Continued revision of
      forms
   April 2009 –
    – Karen Zulkowski!
        • Treatment Guidelines
          for Pressure Ulcers
Why data?
    Helps us measure where we are
     and set goals for where we want to
     be
Prevalence
   The measurement of new and old
    pressure ulcer cases and is usually
    assessed on a cross sectional one
    time basis.


Number of patients with pressure ulcers
                                           X 100
Number of patients assessed (population)
Incidence
   Incidence (nosocomial pressure ulcers) refers
    to the new cases of pressure ulcers occurring
    over a given time period.
   An incidence study report may be used as a
    facilities quality indicator or to determine the
    compliance and effectiveness of prevention
    interventions.

Number of patients with pressure ulcers
                                               X 100
Number of patients assessed (population)
                Our data

10
8
6
4
2
0
     Base   December     January        February

            # Patients   POA       HA
Braden Risk Assessment -
90

80

70

60

50
      Dec        Jan           Feb

             Completion Rate
        Pressure Ulcer Incidence Rates

12%

10%

8%

6%

4%

2%

0%
      Dec               Jan              Feb

                     ACF      ECF
December
 – Average LOS = 4 days
 – Average age = 62
 – Average Braden score = 18.44
    • Lowest braden score = 9
 – Of those incomplete or un-assessed, patients
   did have primary or secondary dx placing them
   at risk
    •   Cancer with recent chemotherapy
    •   Pneumonia
    •   Heart failure
    •   Poor mobility
    •   Poor nutrition
January
 –   Average LOS = 3.1           – Cases identified
 –   Average age = 63               • 8 Patients
 –   Average braden = 18.24         • 8 POA
 –   Of those incomplete or         • 1 FA
     un-assessed, patients       – Stages/Sites
     did have primary or            • Stage I – 1 Back, 3
     secondary dx placing             Coccyx
     them at risk                   • Stage II – 1 Toes, 2
      • Medline products in           Coccyx
        use – other preventive      • DTI - Elbow
        policies/education in
        process
February
–   Average LOS 3.18 days          – Cases identified
–   Average age = 61                  • 4 Patients
–   Average Braden = 17.60            • 5 POA
–   Of those incomplete or un-        • 0 FA
    assessed, patients did have    – Stages/Sites
    primary or secondary dx           • Stage I –1 -Foot/heel,
    placing them at risk              • Stage II –1- Knee, 2 -
     • Medline products in use –        Coccyx
       other preventive               • Stage III – 1-Ankle
       policies/education in
       process
Why is “Source of Admission”
important?
                Broadens the spectrum
                 of education
                 – Assisted Living Facilities
                    • To include or not to
                      include? What’s the right
                      thing to do?
                 – Nursing Homes
                 – Other hospitals
                 – Home
New “things”
 Medline products
 Pressure Ulcer Prevention Policy
 Nursing Interventions for Pts @ Risk
  for Pressure Ulcers
 Pressure Ulcer Admission Orders
 Admission Assessment update
 Patient Care Record update
 Care Plan update
New “things” continued
 Wound Assessment & Photo
  Checklist
 Digital cameras/bags
 Wound photography policy
 Patient Turn Clock
 Bath Assessment Record
 Prevention Administration Record
Resources
   Medline
    http://www.medline.com/pressureulcerpre
      vention/default.asp
   New staging guidelines
    http://www.npuap.org/
   Online braden scale competency
    http://www.nursingcenter.com/prodev/ce_
      article.asp?tid=751548