Lowering Pressure Ulcers through Evidence & Process-

A spotlight on Gastrointestinal Nursing

Health Management TeamLavon Beard Yvette Glenn Britt McilwainDaran Brown Cowanda Lawrence Dr. Maria OquendoAnnie Shedlarski

What is a Pressure Ulcer?

Background on W7N

Impact of Pressure Ulcers on Patient Outcomes

According to a 2012 UCLA study, “seniors who developed pressure ulcers were more likely to die during their hospital stay, to have longer stays in the hospital, and to be readmitted to the hospital within 30 days of their discharge.”

University of California - Los Angeles. October 2, 2012. “Hospital bedsores linked to patient mortality” .Journal of the American Geriatrics Society

UAB Nursing Pressure Ulcer (PU) BundleA guideline of best evidence-based practice interventions

Document comprehensive skin assessment Initiate the Nursing PU Care Protocol if present on

admission Document the Braden score

For Braden score of 17 or less, initiate the Nursing Skin Care Protocol

Document and assess skin on every shift

Prevent Skin breakdown using: Barrier cream/wipes; dressings; body aligners; & Waffle boots

Turn your patient at least every 2 hours Do NOT over pad the bed Use slide sheets & Safe Patient Handling Equipment

Education & Nutrition WOCN Orders And Powernotes

ON ADMISSION

DAILY CARE

PREVENTION

TREATMENT

New Processes on W7N1. Admission- Double check by two RN’s2. How do we ensure accountability

Management team active participants- 2 audits per quarter.3. Quality Huddles each shift

A. 10am/10pm quality huddles with pressure ulcer focusB. Sheets used to trace patients progress/deterioration

Room # Name Status/Injury Plan Quality Bundle Equip present

W754 Cri Healed Sacrum Q2h turns  

W747 Rob At Risk ? Q2h turns/WOCN consult  

W748 Pet Stage 1 sacrum Q3h turns  

W742 Wat At Risk- sacrum Mepilex- Q2h turns  

W736 Lof R heel non-blanch, Q2h Waffle boots

W734 Fos Purple sacrum/non deep tissue

Q2h Waffle/Wedge/Mepilex

W728 Qui At risk, sutures on bottom

Q2h turns Wedge

W724 McC At risk Q2h turns Waffle boots

W718 Whi At risk Q2h turns Wedge

W716 Hay At risk Q2h turns  

How do we Measure our Performance? The Dashboard.

National Database of Nursing Quality Indicators (NDNQI®)

The measurement of hospital-acquired pressure ulcers allows organizations to:• Assess the quality of their care;• Evaluate quality improvement initiatives, and;• Examine institutional structures and processes that may influence

their occurrence.Nursing Quality Chair

Oversees the Survey process & Reports results to Hospital & Nursing

Quality Councils

WOCN Led TeamsTrained and certified

WOCNs

WOCN Led TeamsLead Teams of Trained

RN staff

WOCN Led Teams

In the collection of NDNQI Data

Data AnalystCompiles and enters all survey

forms into the database

Results: NDNQI for W7N HAPU

FYTD 14 Actual

FY 14 Target

Oct - 13

Nov - 13

Dec - 13

J an - 14

Feb - 14

Mar - 14

Apr - 14

May - 14

J un - 14

J ul - 14

Aug - 14

Sep - 14

30.6 N/ A 31.1 30.4 29.4 31.5 30.7

0.98% 2.14% 0.00% 0.50% 1.80% 1.60%

1.67% 2.14%0.00% 1.26%Unit Acquired Pressure Ulcers 0.00% 0.00% 0.00%

Hospital Acquired Pressure Ulcers 0.00% 3.33%

CY QTR 4 2013 Oct, Nov, Dec

CY QTR 1 2014 Jan, Feb, Mar

CY QTR 2 2014 April, May, June

Hospital Acquired Pressure Ulcers

MOST RECENT QTR (NDNQI DATA)CY QTR 3 2013 July, Aug, Sept

MeasuresAverage Daily Census

SAFETY

At or above target Failing Measure

Prepared and maintained for use in the Quality Improvement Process of the University of Alabama Hospital. Privileged and confidential pursuant to the Code of Alabama, Section §6-533, §22-21

W7N DASHBOARD-FY 2014Success

Results: Control Chart for W7N HAPU

Recommendations & Next Steps

Is this a Scalable process throughout UABEvidence is clear, commitment is the

question?The Hawthorne effect is powerful

Discussion