orthopedic / device related nosocomial wounds scahq meeting may 14, 2010
TRANSCRIPT
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 TED hose Heel protector Bucks traction
Action Plan - June 2006 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
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
July:
Action Plan implemented
March:Trigger revision
Nosocomial Wounds
5 TKA
2 Other
5 TKA
2 Hip
2 Other
7 TKA
5 Hip
2 Femur
0 TKA
1 Hip
1 Femur
1 TKA
3 Hip
4 Femur
1 Tibia
1 TKA
3 Hip
1 Femur
1 THR
2 Hip
1 Ankle
1 Femur
2 TKA
2 Hip
1 Hip 1 Hip 1 TKA
2 Hip
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
Consults vs. Admissions
consults 198 239 249 270 315 317 319 312 352 342 387 355 356 382 397 341 405
admissions 3223 3000 3017 3166 3257 3068 3307 3062 2590 2604 2630 2520 2483 2457 2417 2504 2635
Never Events
Apparent Cause Meeting All Stage III and IV nosocomial pressure
ulcers Occurrence reports completed by wound
care nurses
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?