Implementation of a Skin Surveillance and Prevention Program to Reduce the Rate of Nosocomial Pressure Ulcers

1. Implementation of a Skin Surveillance and Prevention Program to Reduce the Rate of Nosocomial Pressure Ulcers

2. Kim Reeks Cheri Finke Shoney Garcia Grace Hooker Lisa Johnson Vicki Kaczkos Judy King Erin Mahoney Jason Morandi Espi Oliveros Kathy Przybyl Ruth Schenn Gen Spencer Team Members

3. Aim Statement • Reduction in the 4SICU rate of nosocomial pressure ulcers by improving assessment of high risk patients and the implementation of evidenced based pressure ulcer prevention interventions • Achieve 100% compliance in completing skin breakdown risk assessment on all 4SICU patients by April 2007 • Increase percentage of patients receiving all measures of pressure ulcer preventative care to 90% by April 2007 • Maintain 4SICU nosocomial pressure ulcer rate below NDNQI national mean for adult critical care units

4. Barriers • Knowledge deficit and non-compliance of nursing staff regarding pressure ulcer interventions • Non-preventable patient factors which increase risk of pressure ulcer development • Delayed clearance of TLS spine which prohibits advancement of activity level • Insufficient or inappropriate equipment available to mobilize patients

5. Formation of a skin care team Development of audit tool Pressure ulcer preventative care audit three times per week Nosocomial pressure ulcer audits monthly Education plan Unit competency Skin Care Education board Skin Care Product board Weekly focus on interventions and prevention methods New cardiac chairs were purchased with pressure reduction seat cushions and increased weight limit Increased the unit supply of pillows for turning and proper positioning Increased use of slide board for bed to chair transfers Solutions Implemented

8. Results • All target goals have been met • The greatest improvements can be seen in the completion of the Braden Scale Risk Assessment, documentation of skin breakdown and initiation of plan of care • Implementation of prevention methods have increased especially in the use of the appropriate bed surface

9. Nosocomial Pressure Ulcer Prevalence Rates in 4SICU 30% 25% 4SICU Rate 20% NDNQI Mean 15% 4SICU Mean Rate 4SICU Mean = 11.50 10% 5% 0% June-06 Sept-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 March-07 Month DEFINITION: Percentage of patients with a nosocomial pressure ulcer NUMERATOR: Patients who develop a pressure ulcer while in 4SICU DENOMINATOR: All patients assessed in 4SICU ANALYSIS: Review of the results demonstrates no change in nosocomial pressure ulcer rates. Confidential for Quality Improvement Purposes Only

13. Next Steps • Reclassify high risk patients as a Braden Score less than 16 (previously Braden Score less than 11) • Posting of monthly audit results for staff • Development and implementation of a shearing reduction plan • Development of Risk Assessment and Pressure Ulcer Prevention protocol pocket cards for all staff • Develop unit standards for activity and documentation requirements for exceptions • Implementation of the “Fluff and Double Pillow Protocol” • Addition of TLS clearance to the ICU checklist • Initiation of “Days Since Last Pressure Ulcer” sign to monitor real time progress of pressure ulcer prevention • Include Skin Care Program to nursing and PCT unit orientation • “STU” clipboard covers • Initiation of a monthly performance review conference to review intervention compliance and patient who develop a pressure ulcer