The Wisconsin Pressure Ulcer Coalition (WPUC) 2011

2. The Wisconsin Pressure Ulcer Coalition (WPUC) 2011 Jody Rothe, RN, WCC Quality Consultant January 27, 2011

3. Objectives • Describe the WPUC structure and how to use the activities to improve your pressure ulcer prevention • Determine next steps to improve your pressure ulcer prevention program

4. Thank You • Thank you for being a 2011 WPUC member • Goals of the WPUC • Reduce and prevent pressure ulcers • Foster cross setting communication

5. 2011 Structure • Data submission • Monthly e-newsletter • Webinars • Community meetings • Educational DVD • Pressure ulcer bundle

6. www.metastar.com

7. Points of Quality

8. Select Setting Nursing Home Page Hospital Page

9. Pressure Ulcer Web Page

10. Data • Data collection • Data submission • Data tracking & analysis • E-news data • Data tool posted under resources-data: • http://www.metastar.com/web/Default.aspx?tabid=339

11. Data Measures • Timely Risk Assessment: Number of admissions that have a risk assessment performed within eight hours of admission • Numerator: ______________________________ • Denominator: ______________________________

12. Data Measures (Cont.) • Timely Skin Assessment: Number of admissions that have a documented comprehensive skin assessment performed with eight hours of admission • Numerator: ______________________________ • Denominator: ______________________________

13. Data Measures (Cont.) • Timely Preventive Strategies: Number of patients/residents/clients who receive preventive strategies within 24 hours of being identified as at risk • Numerator: ______________________________ • Denominator: ______________________________

14. Data Measures (Cont.) • Pressure Ulcer Prevalence: Number of patients/residents/clients with pressure ulcers at one point in time during the month • Numerator: ______________________________ • Denominator: ______________________________

15. Data Measures (Cont.) • Facility Acquired Rate: Number of residents with facility acquired pressure ulcers • Numerator: ______________________________ • Denominator : ______________________________

16. Data Measures (Cont.) • Stage of Facility Acquired Pressure Ulcers • Stage I _____ • Stage II _____ • Stage III _____ • Stage IV _____ • Unstageable _____ • Deep Tissue Injury _____

17. Data Resources

18. Data Tool Sample

19. E-Newsletter • Sent monthly via e-mail by Missie Bradley • Aggregate data • Upcoming events • Resources/tips of the month

20. E-Newsletter (Cont.) • Submit a question to jrothe@metastar.com to have the question and answer posted in an e-newsletter • Link to resources on website: • http://www.metastar.com/web/Default.aspx?tabid=339

21. Webinars • Invite will alert members of the webinar • Reminders in e-news • Three more webinars in the first half of 2011 • Survey Monkey • Past webinars at this link • http://www.metastar.com/web/Default.aspx?tabid=342

22. Community Meetings • Why do I need to host a meeting? • What do I do with the information? • How can the meeting reduce and prevent pressure ulcers?

23. Community Meeting Toolkit • Community Meeting Toolkit • http://www.metastar.com/web/Default.aspx?tabid=339 • Next Steps

24. Educational DVD • Mailed to contact listed on enrollment form • Cross setting DVD for education of all staff

25. Pressure Ulcer Bundle • How does my team use “The Bundle”? • CD sent to the contact on the enrollment form • Website Link: • http://www.metastar.com/web/Default.aspx?tabid=339

26. Breaking Down “The Bundle” • Section 1: Organizational Commitment to Pressure Ulcer Prevention & Management • Section 2: Pressure Ulcer Prevention & Management Policies • Section 3: Educating Staff • Section 4: Screening, Assessing & Monitoring Pressure Ulcers

27. Breaking Down “The Bundle” (Cont.) • Section 5: Prevention & Treatment of Pressure Ulcers • Section 6: Care Planning for Pressure Ulcers • Section 7: Quality Improvement Tools • Section 8: References

28. Section 1: Organizational Commitment to Pressure Ulcer Prevention & Management • Commit your organization • Institute prevention program based on guidelines (AHCPR, AMDA) • Pressure ulcer risk assessments • Pressure relief • Develop plan of care

29. Tools for Pressure Ulcer Prevention & Management • Pressure Ulcers: • Overview • Pressure Ulcers: • Essential systems for quality care • Flow Diagram: • Organizational commitment • Checklist: • Evaluate key steps for organizational system • Plan of Action – Pressure Ulcers: • Organizational commitment

30. Section 2: Pressure Ulcer Prevention & Management Policies • Pressure Ulcer Prevention and Management • Assess, revise, develop policy & procedures • Develop protocols for screening for pressure ulcer risk • Monitoring prevention and treatment • Developing care plan

31. Tools For Pressure Ulcer Prevention & Management • Checklist provided for assessing pressure ulcer policies • Outline of component of a pressure ulcer prevention & management policy • Pressure ulcers: • Annotated guidelines

32. Section 3: Educating Staff • Key areas to include in training • Screening for resident risk factors • Prevention and early treatment options

33. Key Areas to Include in Staff Education • Pressure ulcer assessment • Monitoring treatment & prevention for residents with pressure ulcers • Treatment options for pressure ulcers • Accurate documentation • Care planning/MDS coordination

34. Tools for Staff Education • Checklist: • Assessing staff education and training • National Pressure Ulcer Advisory Panel Pressure Ulcer Treatment: • A competency-based curriculum • Content outline

35. Section 4: Screening, Assessing, & Monitoring Pressure Ulcers • Screening tool should be done upon: admission, readmission, a change in condition, each MDS assessment • When performing a pressure ulcer risk screen, the tool should address the following: • Impaired mobility • Incontinence/moisture • Nutritional deficits • Altered level of consciousness • Altered sensory perception

36. Assessment & Monitoring • Wound assessment should occur upon admission and at specified intervals thereafter. The pressure ulcer assessments should be at least weekly and include: • Site/location • Size • Pain • Stage • Drainage • Appearance • Physical health • Psychosocial status • Nutrition/ hydration status-nutritional assessment • Pain status-comprehensive pain assessment

37. Tools for Screening, Assessing & Monitoring Pressure Ulcers • Checklist: screening for pressure ulcer risk • Flow diagram-pressure ulcers: • Risk Assessment • Pressure ulcer risk scales • Checklist: • Assessment & reassessment & monitoring treatment & prevention of pressure ulcers • Assessment and tracking tools examples

38. Section 5: Prevention & Treatment of Pressure Ulcers • Early prevention intervention may include: • Protecting skin against effects of pressure, friction, & shear • Protecting skin from moisture • Encouraging optimal nutrition and fluid intake

39. Treatment • Clinical Practice Guidelines provide current principles and protocols for prevention and treatment • 1996 AMDA Pressure Ulcer Clinical Practice Guideline: Pressure Ulcers • 1999 AMDA Clinical Practice Guideline: Pressure Ulcer Therapy Companion • AHCPR Clinical Practice Guideline #3: Pressure Ulcers in Adults: Predication and Prevention • AHCRP Clinical Practice Guideline #15: Pressure Ulcer Treatment

40. Tools for Prevention & Treatment • Pressure Ulcer Prediction & Prevention Algorithm • Clinical Algorithm: • Management of Pressure Ulcers – Overview • Clinical Algorithm: • Ulcer Care • Clinical Algorithm: • Management of Tissue Loads • Pressure Ulcers: • Communication with Physician • Provides a sample form that nursing staff can complete before contacting a physician

41. Section 6: Care Planning for Pressure Ulcers • Development of a care plan • Interdisciplinary team needs to be involved • Areas of risks and interventions should be addressed in the resident’s care plan as they apply to specific problems • Education of the resident and family

42. Care Plan • Once care plan developed, the process involves: • Implementation of the plan of care • Monitoring the response to the plan of care • Ensuring oversight (person(s) or team) for implementation • Reassessment of the plan of care

43. Tools for Care Planning • Checklist: • Developing a pressure ulcer care plan • Education tool for residents & families: • Pressure ulcers

44. Section 7: Quality Improvement • A systems approach to Quality Improvement • Through analysis of current process that make up the systems, the Pressure Ulcer Quality Improvement Workgroup can determine which problems are areas that need improvement

45. Tools For Quality Improvement • Worksheets • Plan of Action – Pressure Ulcers: • Organizational commitment

46. Root Cause Analysis

47. Section 8: References • Pressure Ulcer Reduction and Prevention Project “The Bundle”

48. The Six Elements of IHI Bundle • Conduct a pressure ulcer admission assessment for all patients • Reassess risk for all patients daily • Inspect skin daily • Manage moisture: keep patient dry & moisturize skin • Optimize nutrition and hydration • Minimize pressure

49. Pressure Ulcer Admission Risk & Skin Assessment • Conduct • For all patients • For risk • For detection • Gather data • Braden Scale, Norton Scale

50. Daily Risk Reassessment • Triggers • Mobility • Incontinence • Nutrition • Procedures • Preventive Steps • Policy & procedure