Transcript Slide 1

S.O.S.
Save Our Skin
Confidential: For Quality Improvement Purposes Only
Reduction of
Nosocomial
Pressure Ulcers
on 5 NEW
Confidential: For Quality Improvement Purposes Only
Physicians:
Administration:
Terry Light
Paul Gorski
Steve Gnatz
Elmer Dulce
Tim Rapp
Ewa Jaraczewska
Anthony Rinella
Nursing:
Center for Clinical
Mary Vondriska
Effectiveness:
Kathy Xenakis
Mary Altier
Jodi Blaszcyk
Administrative
Victoria Davidson-Bell
Assistant:
Yolanda Corral
Confidential: For Quality Improvement Purposes Only
Forces of Magnetism
Force 6: Quality of Care
Force 7: Quality Improvement
Force 11: Nurses as Teachers
Force 13: Interdisciplinary
Relationships
Confidential: For Quality Improvement Purposes Only
Opportunity For Improvement
Nearly one million people develop pressure ulcers annually while approximately
60,000 acute care patients die from related complications 1
Recent data suggest an increase of hospital acquired pressure ulcers on 5NEW.
1 Institute for Healthcare Improvement. Relieve the Pressure and Reduce harm. May 21st, 2007. Accessed at http://ihi.org and
http://www.qualityforum.org
Reasons identified include:
Missing nursing documentation of skin assessment upon admission to unit.
RN & PCT knowledge deficit regarding bladder and bowel program.
Patients sitting in a chair for too long.
Patients wearing ill fitting shoes
Actual development of pressure ulcer.
No field in EPIC to document healed ulcers.
Confidential: For Quality Improvement Purposes Only
Project Aim Statement
Reduction of the pressure ulcer rate
below the adult rehab mean
Reduction of the incidents of
nosocomial pressure ulcers on 5 NEW
to zero.
Confidential: For Quality Improvement Purposes Only
Solutions Implemented
Obtained physician support for project.
In serviced 100% of RN’s, PCT’s and SC’s on
Save Our Skin (SOS) Program.
Piloted SOS program beginning 3/03/08 on 5
NEW, including patient, family & staff.
BRADEN scale assessment every Wednesday
beginning 7/1/08.
Implementation of BRADEN scale order sets
based on BRADEN scale score.
EPIC documentation now includes “HEALED” date.
Confidential: For Quality Improvement Purposes Only
Solutions Implemented
Initiate skin care team consisting of RN’s and
PCT’s to perform skin care rounds every Tuesday
beginning 3/4/08.
Monitor incidence of nosocomial pressure ulcers
on 5NEW.
Resolve the number of pressure ulcers of patients
during their stay on 5NEW.
Report outcomes to key stakeholders on a regular
basis and post results.
Monitor pressure ulcers on a daily basis report
results to key staff.
Development of EPIC daily report to monitor
pressure ulcer prevalence.
Confidential: For Quality Improvement Purposes Only
Patient & Family Education
Instruct patient & family on reasons for the
following:
•
•
•
•
•
•
Toileting every 2 hours
Elevating heels
Pressure relief exercises while in chair
Turning every 2 hours while in bed
Using a chair cushion
Back to bed program
Confidential: For Quality Improvement Purposes Only
5 NE W Nosocom i a l S ki n Ul ce r Ra te
Quarter
NOSO Rate
Upper Quartile
Adult Rehab Mean
Lower Quartile
2 Q 06 Jun
13.6
9.09
5.62
0
3 Q 06 Sep
14.3
9.09
5.52
0
4 Q 06 Nov
29.2
10.34
7.72
0
1 Q 07 Mar
8.7
10.00
6.71
0
2 Q 07 May
12.5
11.11
6.69
0
3 Q 07 Sep
8.7
9.31
6.15
0
4 Q 07 Nov
4.2
M ul ti -Li ne - i ndi vi dua l s
30
25
20
15
10
5
N
ov
07
Q
4
Q
3
2
Q
07
07
Se
p
M
ay
M
ar
07
Q
1
4
Q
06
Q
3
06
Se
p
Ju
n
06
Q
2
N
ov
0
NOSO Rate
Upper Quartile
Adult Rehab Mean
Lower Quartile
Confidential for Quality Improvement Purposes Only
Data demonstrates a decrease in the amount of nosocomial pressure
ulcers occurring on 5NEW. 4Q 07 demonstrates a rate below the
mean rate.
Braden Scale Compliance
5 NEW
UCL
110
SO S Project Implementation
Goal 100%
100
Braden Scale Percentage
90
80
Mean
Mean
Bra de n Asse ssme nt re minde rs poste d: ve rba l cue s give n
70
60
LCL
50
20
07
(N
ug
=8
us
5)
t2
00
7
(N
=1
S
04
ep
)
t2
00
7
(N
O
=8
ct
3)
20
07
(N
=1
N
08
ov
)
20
07
(N
=8
D
ec
0)
20
07
Ja
(N
nu
=8
ar
1)
y
20
08
Fe
(N
br
=4
ua
8)
ry
20
08
(N
M
=5
ar
7)
ch
20
08
(N
=5
1)
=8
5)
(N
A
Ju
ly
20
07
=1
07
)
(N
ay
20
07
20
07
M
Ju
ne
=7
9)
(N
=8
1)
(N
A
pr
M
ar
20
07
(N
20
07
Fe
b
Ja
n
20
07
(N
=1
03
)
=1
09
)
Audit q Wednesday begun
For Quality Improvement Purposes Only
Braden scale assessment: recent data shows marked improvement
over the last 5 reporting periods. Last 6 reporting periods demonstrate 100%
compliance.
Pressure Ulcer Prevelance
5 NEW
16
14
14
12
11
Number
10
10
9
10
9
8
S OS P r o j e c t I m p l e m e n t a t i o n
6
6
March 2008
6
Confidential: For Quality Improvement Purposes Only5
4
2
4
2
2
2
1
0
October 2007
(N=52)
November
2007 (N=49)
December
2007 (N=50)
January 2008 February 2008
(N=48)
(N=57)
March 2008
(N=51)
April 2008
(N=47)
Month
Number of patients on admission w ith pressure ulcers
Number of patients that developed nosocomial pressure ulcers during stay
Increase of number of pressure ulcers in March 2008 related to increase awareness of
staff to assess patients and report pressure ulcers.
Confidential: For Quality Improvement Purposes Only
Next Steps
 Monitor outcomes of S.O.S program that was





instituted in March 2008.
Reeducate staff as needed.
Monitor number of nosocomial pressure ulcers
that are treated and resolved prior to
discharge.
Monitor BRADEN scale compliance every
Wednesday.
Collaborate with physical therapy to institute
S.O.S program.
Celebrate Successes!!!
Confidential: For Quality Improvement Purposes Only
Supplies used:
 Every RN and PCT was given the
following tools to facilitate with skin
assessments:
•
•
•
•
•
Pressure Ulcer Assessment Tool
Tissue Assessment Guidelines
Pressure Ulcer Staging
Pressure Point Portrait
Hand held mirror to assist in looking at elbows
and heels
Confidential: For Quality Improvement Purposes Only