Transcript Slide 1

Vancouver Coastal Health - Richmond
Pressure Ulcer Prevention
An Interdisciplinary Approach
BCPSQC Quality Forum 2015
Lisa Stewart
Maria Torres
Disclosure Statement
Both presenters are employees of Vancouver
Coastal Health and declare no potential
conflicts of interest.
International NPUAP-EPUAP
Pressure Ulcer Definition
“A pressure ulcer is localized injury to the skin
and/or underlying tissue usually over a bony
prominence, as a result of pressure, or pressure in
combination with shear…”
Why?
(do we need to be concerned about pressure ulcers?)
Pressure ulcers can develop in less than 12 hours
Prevention is better than treatment
Pressure ulcers have a significant impact on quality of life.
Prevention Strategies =
Pressure Ulcers =
Quality of Care
Our Strategy
Innovative
Respectful
Sustainable
Act
Plan
Study
Do
evaluated current state
identified resources
developed the project plan
challenge status quo
Pressure Ulcer Risk Scale completed by the interdisciplinary team at R-Care
Why?
(in team rounds?)
Activity
Moisture
Mobility
Sensory Perception
Nutrition
Pressure Ulcer risk assessment and care planning is interdisciplinary
Hydration
Friction & Sheer
Lab Values
Medical History
Medical Status
Comorbidities
BMI
Age
…how does this apply to my practice
collaboration
Promotes Awareness within the Interdisciplinary Team
Supports Pressure Ulcer Prevention as part of the team’s standard work
sustainability
DO
NOT
STOP
shared work
The whole is
greater than the
sum of its parts
- Aristotle
Utilization of health discipline expertise
Can the interdisciplinary team efficiently complete the Braden Scale?
Can the interdisciplinary team accurately complete the Braden Scale?
Comparison of Total Braden Scale Score - Interdisciplinary Team and WOCN
40
35
30
25
IDT Total
20
WOCN Total
15
10
5
0
A
C
E
G
I
K
M
O
Q
S
U
W
Y
AA
CC
EE
Comparison of Braden Scale Score - Interdisciplinary Team and WOCN
3
2.5
2
1.5
1
0.5
0.4
0.5
0.18
0.18
Sensory
Moisture
0.4
0.25
0
Activity
Mobility
Nutrition
Friction and
Shear
√
Pressure Ulcer
Prevention
Best Practice
… 5 weeks later
Richmond Hospital Pressure Ulcer Prevention Accreditation Standards Met
5
4
3
2
1
0
Medicine 1
Medicine 2
medicine 3
Surgery 1
Surgery 2
Palliative Care Critical Care
Measurement
Chart Audit Results
Richmond Hospital
Patients With a Completed Pressure Ulcer Risk Screen (%)
Richmond Hospital Patients with a Completed
Pressure Ulcer Risk Screen (%)
January-December 2014
100
98
91.2
100
100
99.7
98.6
96
80
60
40
20
0
2014 Average 97.3%
94.6
97.3
97.7
Prevalence & Incidence
What we asked for…
we got more than we asked for…
teams talking
team pride
team ownership
Pressure Ulcers
February 2015
No Incident
Incident
Are we identifying and communicating the risk of a developing pressure ulcer
Can we see it coming?
“The process is great for allowing you to
very quickly visually note the problem
areas for that particular patient
ultimately allowing you to prevent sores
from progressing”
“Although we all know the key
boney areas of the body most at
risk, every patient is different.
This form allows for patient
centered documentation and
prioritization of your care
strategies and goals”
“Having a designated location and a standardized
way of documentation/communication assures us
that patients have their pressure ulcer risks
addressed every single day”
“It makes you really think about and
consider the high risk skin areas. It also
allows the nurse to see what areas may
be of concern specific to that patient and
concentrate on their assessment and care
before they progress”
“It is a good tool in that it allows you to
see immediately when there has been a
change in a patients skin condition”
Pressure Ulcer Prevalence Palliative Care
January-October 2014
6
5
5
4
3
2
1
1
1
1
0
0
January
February
0
0
0
March
April
May
July
August
October
Pressure Ulcer Prevention in the Operating Room
What?
Did we learn…
Be dynamic
Be present
Listen
Say thank you
Thank you
“Around here, however, we
don’t look backwards for very
long. We keep moving forward,
opening up new doors and
doing new things…and
curiosity keeps leading us
down new paths”
- Walt Disney