Pressure Injuries: Prevention That Works - NPUAP€¦ · incorporate into your PIP program. ... Pressure Injuries: Prevention That Works ... Braden pressure ulcer risk scores to identify
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• Recognizes innovation- standing agenda item (tests of change)
• Promotes PIP beyond organization, into the community- WTA Community
Program
Greetings from Mayo Clinic Rochester
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One Size Does NOT Fit All
Structure Elements
• Stability of Clinical Staff
• Experts near the Front Lines
• Presence and Sophistication of
Electronic Health Record
• Materials Management and Purchasing
Department
• Administrative Support
• Legal Department liaison
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Process Elements
• Assessment
– CWOCN/CWCN/CNS
– Wound Therapy Technicians
– Expert Staff Nurses
• Skin Savers Teams on the Units
• Availability of Educational Offerings
– Physical Therapy Wound Specialists (CWS)
– Staging (Are we all speaking the same
language?)
Process Elements
• Communication
– Electronic Notifications through the EHR
– Types of Notifications
• Braden Scores for high risk patients
• Certain types of skin alterations
– Clinical Cameras
• Data security
• Technical expertise
• Accessibility
– Multidisciplinary Team Notification
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Process Elements
• Materials Management and Purchasing
– Contracts
– Nursing Supply Value Analysis Committee
• Multi-disciplinary
• Administrative Support
– Resource Commitment (It Takes a Village)
• Pressure Ulcer Prevention Work Group
• Event Analysis
• Personnel
• Support for Education
Process Elements
• Interventions
– Skin Care Bundles for Prevention
• Risk and skin assessments
• Progressive mobility
• Moisture management
• Nutrition
– Treatment Algorithms
– Process Measures Monitoring
• Standardized but customizable care plans
• Follow up compliance reports
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Process Elements
• Interventions
– Evidence Based Practice (the never-ending
story)
• Dressings
– Silicone border
• Bed Surfaces
– Support Surface Standards Initiative (S3I)
• Building the Body of Evidence
– Non-Contact Ultrasonic Mist Therapy
– Turning schedules and reminders
Process Elements
• Event Data Analysis
– Medical Device
Related Pressure
Injuries
• Compression Wraps
• Continuous Positive
Airway Pressure
(CPAP) masks
• Cervical Collars
– Translational
Research
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Research and QI: Pay it Forward
• Cervical Collars
• Braden Scale Scores
• Anti-Shear Technology
– CPAP Masks
– Pre-hospital Transport
Tescher AN, Rindflesch AB, Youdas JW, Jacobson TM, Downer LL, Miers AG, Basford JR, Cullinane DC, Stevens SR, Pankratz VS, Decker PA. Range-of-motion restriction and craniofacial tissue-interface pressure from four cervical collars. J Trauma. 2007 Nov; 63(5):1120-6. PMID:17993960.
DOI:10.1097/TA.0b013e3180487d0f.
Tescher AN, Branda ME, Byrne TJ, Naessens JM. All at-risk patients are not created equal: analysis of Braden pressure ulcer risk scores to identify specific risks. J Wound Ostomy Continence Nurs. 2012 May-Jun; 39(3):282-91. PMID:22552104. DOI:10.1097/WON.0b013e3182435715.
Anti-Shear Technology – CPAP Masks
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Anti-Shear Technology – Pre-Hospital Transport
There’s got to be a pony in here somewhere…
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Conclusion
An effective and sustainable PIP program can be developed using the four Magnet Model domains of:
• Transformational leadership
• Structural empowerment
•
• Exemplary professional practice
• New knowledge; innovation and improvement.
Successful implementation of these elements yields measurable positive outcomes.(W. V. Padula, Mishra MK, Makic MB, Valuck RJ, 2014 Apr)
References
• Agency for Healthcare Research and Quality (AHRQ). (2011 July). AHRQ toolkit helps to prevent hospital-acquired pressure ulcers: Research Activities. Rockvill, MD: AHRQ.
• Berwick, D. M., Calkins DR, McCannon CJ, Hackbarth AD. (2006 Jan). The 100,000 lives campaign: setting a goal and a deadline for improving care quality. JAMA, 295(3), 324-327.
• Black, J. M. (2005). National Pressure Ulcer Advisory Panel: Moving toward consensus on deep tissue injury and pressure ulcer staging. Adv Skin Wound Care, 18, 415.
• Clark, M. L. (2006 Jun). The Magnet Recognition Program and evidence-based practice. J Perianesth Nurs, 21(3), 186-189.
• Creehan, S.; Cuddigan,J.; Gonzales, D.; Nix, D.; Padula, W.; Pittman,J.; Pontieri-Lewis, V.; Walden, C.; Wells, B.; Wheeler, R. The VCU Pressure Ulcer Summit-Developing Centers f Pressure Ulcer Prevention Excellence: A Framework for Sustainability. J Wound Ostomy Continence Nurs. 2016;43(2):121-128
• Donabedian, A. (1992). Quality assurance. Structure, process and outcome. Nurs Stand, 7(11 Suppl QA), 4-5.
• Duncan, K. (2007). Preventing Pressure Ulcers: The Goal is Zero. The Joint Commission Journal on Quality and Patient Safety, 33(10).
• Kelleher, A. D., Moorer, A., & Makic, M. F. (2012). Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intensive care unit: a quality improvement project. J Wound Ostomy Continence Nurs, 39(2), 152-157. doi: 10.1097/WON.0b013e3182435409
• LeMaster, K. (2007). Reducing Incidence and Prevalence of Hospital-Acquired Pressure Ulcers at Genesis Medical. The Joint Commission Journal on Quality and Patient Safety, 33(10).
• Lyder, C. H., Grady J, Mathur D, Petrillo MK, Meehan TP. (2004). Preventing pressure ulcers in Connecticut hospitals by using the plan-do-study-act model of quality improvement. Jt Comm J Qual Safe, 30(4), 205-214.
• Morton, A., Mengersen K, Waterhouse M, Steiner S. (2010). Analysis of aggregated hospital infection data for accountability. J Hosp Infection, 76(4), 287-291.
• National Database of Nursing Quality Indicators; Pressure Injury Training Modules, version 5; Retrieved February 9, 2017. https://members.nursingquality.org/ndnqipressureulcertraining/