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Hospital Acquired Pressure Ulcers

Hospital Acquired Pressure Ulcers. Background – Harm. Incidence of Stage II or greater > Hospital-Acquired Pressure Ulcers ranges from 5% - 9 % 60, 000 die from pressure ulcer complications each year. Background – Harm. Decrease quality of life and functionality

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Hospital Acquired Pressure Ulcers

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  1. Hospital Acquired Pressure Ulcers

  2. Background – Harm • Incidence of Stage II or greater > Hospital-Acquired Pressure Ulcers ranges from 5% - 9% • 60, 000 die from pressure ulcer complications each year

  3. Background – Harm • Decrease quality of life and functionality • Increase risk of other complications • Increase hospital mortality • Increase need for skilled care and rehab after discharge

  4. Who get’s pressure ulcers? • Spinal cord injuries & elderly • Higher incidence in hospitals (38%) not nursing homes (23.9%) • Pressure ulcers do not always signify poor care Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296:974-984.

  5. Co-Morbidities

  6. Pathogenesis for HAPU

  7. Friction

  8. AIM • Reduce the prevalence of hospital acquired Stage II or greater pressure ulcers from 2010 baseline rate by 50% by December 31, 2013

  9. Suggested Measures Outcome Process Skin assessment documented within 24 hours of admission HAPU risk assessment completed within 24 hours of admission • Patients with at least one Stage III or greater hospital acquired pressure ulcer

  10. AIM Primary Driver Secondary Driver

  11. Primary Driver: Conduct Skin & Risk Assessment

  12. Head to Toe Risk Assessment • Within 4 hours of admission • At least every day • Check skin during routine care, i.e. turning, bathing

  13. Take Action! • Plan of care & interventions based on skin & risk assessment

  14. Include Skin Risk in Handoffs

  15. Primary Driver: Manage Moisture

  16. Balance Need for Dry but Moisturized Skin

  17. Use Under Pads to Keep Skin Dry Will hold up to 1 liter & Keep skin dry!

  18. Use ‘Reminders” 3 P’s P = Pain P = Potty P = Position or Pressure

  19. Primary Driver: Optimize Hydration & Nutrition

  20. Monitor… • Weight • Hydration status

  21. Offer Appetizing Food & Drink Choices • Tempt patient with food & drink they like • Consider cultural food preferences

  22. Additional Interventions: • Consult a registered dietician • Consider nutritional supplements

  23. Primary Driver: Minimize Pressure, Shear, & Friction

  24. Turn! Turn! Turn! • Turn & reposition at least every 2 hours

  25. Pressure Relieving Special Surfaces & Tools • Foam wedges to position patients • Special pressure redistributing/relieving mattresses • Use pillows only for limbs • Heel boots

  26. Early Mobility & Ambulation Staff driven protocol Get patients moving! • Includes assessment of patient strength & weaknesses • Includes ‘opt out’ for contraindications • Triggers referral to physical therapy based on criteria

  27. Minimizing Shear & Force • Use lifts to reposition • Breathable glide sheets • Limit linen layers to no more than 3 • Foam sacral dressing

  28. Key Resources • AHRQ Toolkit: Preventing Pressure Ulcers in Hospitals • AHRQ Guideline Synthesis on Preventing Pressure Ulcers • National Pressure Ulcer Advisory Panel • IHI: How to Guide on Reducing Pressure Ulcers • Hughes RG (ed). Patient Safety and quality: An evidence-based handbook for nurses. AHRQ Publication No. 08-0043, Rockville, MC: Agency for Healthcare Research and Quality; April 2008 • Gibbons W, Shanks HT, Kleinhelter P, Jones P. Eliminating facility-acquired pressure ulcers at ascension health. JC J Qual Pt Safety. 2006;32(9).488-496.

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