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S.O.S. Save Our Skin

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

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S.O.S. Save Our Skin

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  1. S.O.S. Save Our Skin Confidential: For Quality Improvement Purposes Only

  2. Reduction of Nosocomial Pressure Ulcers on 5 NEW Confidential: For Quality Improvement Purposes Only

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Data demonstrates a decrease in the amount of nosocomial pressure ulcers occurring on 5NEW. 4Q 07 demonstrates a rate below the mean rate.

  11. Braden scale assessment: recent data shows marked improvement • over the last 5 reporting periods. Last 6 reporting periods demonstrate 100% compliance.

  12. Confidential: For Quality Improvement Purposes Only Confidential: For Quality Improvement Purposes Only 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

  13. 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

  14. 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

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