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Orthopedic / Device Related Nosocomial Wounds

Orthopedic / Device Related Nosocomial Wounds. SCAHQ Meeting May 14, 2010. Introduction - 2006. Observed an increase in wounds related to medical devices in post-op hip and knee patients. Devices used on patients with nosocomial wounds. Immobilizer Ace wrap Plexi-pulse Multipodus boot

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Orthopedic / Device Related Nosocomial Wounds

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  1. Orthopedic / Device Related Nosocomial Wounds SCAHQ Meeting May 14, 2010

  2. Introduction - 2006 • Observed an increase in wounds related to medical devices in post-op hip and knee patients

  3. Devices used on patients with nosocomial wounds • Immobilizer • Ace wrap • Plexi-pulse • Multipodus boot • TED hose • Heel protector • Bucks traction

  4. Cause for concern 5 TKA 2 Other 5 TKA 2 Hip 2 Other 7 TKA 5 Hip 2 Femur

  5. Hip/knee protocol Turn Schedule Patient helper (trapeze bar) Foot/heel assessment Patients seen by Wound Care nurses within 72 hours of surgery Continue wound care visits until transferred to SSCP or ARU or discharge Action Plan - June 2006

  6. Results of Initial Action Plan

  7. Wounds by procedure - 2007

  8. Process Improvement – Change to Trigger Tool • Wound Care nurses realized patients with femur fractures were not evaluated • In March, the trigger tool was changed to include femur fractures • Surgical schedule also being checked for surgical procedures; wound care nurses then have opportunity to assess patient

  9. Study of results July: Action Plan Implemented

  10. Nosocomial Wounds July: Action Plan implemented March: Trigger revision 1 TKA 3 Hip 4 Femur 1 Tibia 1 TKA 3 Hip 1 Femur 1 THR 5 TKA 2 Other 5 TKA 2 Hip 2 Other 7 TKA 5 Hip 2 Femur 0 TKA 1 Hip 1 Femur 2 Hip 1 Ankle 1 Femur 2 TKA 2 Hip 1 Hip 1 Hip 1 TKA 2 Hip

  11. Actions Taken • Education of nursing staff • Joint Camp • Patient education provided on wound survelance • Expect visit from wound care nurse • Patients evaluated within 72 hours • Revision of trigger to capture femur fractures • Check surgery schedule

  12. Results * Nosocomial wounds/patients seen by wound care nurses

  13. All Nosocomial Wounds 2006 - 2009 Comparison

  14. Consults vs. Admissions

  15. Never Events • Apparent Cause Meeting • All Stage III and IV nosocomial pressure ulcers • Occurrence reports completed by wound care nurses

  16. Nosocomial Wound Rate Wound rate = # Patients/# patient days x 1000

  17. New cause for concern? • Increase in nosocomial wounds • Unknown causes at this point • Do not feel it is due to lack of education • Competency Fair • Staff Meetings • Next Steps • National trend in increase of nosocomial wounds in ICU • Patients sicker when admitted? • More multi-system organ failure?

  18. Questions?

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