Photo Documentation RUHS Daniel Mazzanti, Guadalupe Zepeda, Herb Ng, and Zobair Moaleji

These! Background MS Patient Settles Pressure Sore Lawsuit Against Home Health Agency for $600,000. Can save these! D

It’s the right thing to do: Better patient safety Better healthcare outcomes It’s the smart thing to do: Regulations are coming spread outlay over time prevent fines and penalties Protection against civil liability Why this proposal? Dan- After big investments, Riverside County hospital still shows $15 million shortfall Since 2015, $25 million has been spent on new hospital equipment, including a new MRI machine and a surgical robot, and $53 million on a new electronic medical records system that allows the hospital to share patient information with other medical centers.

After big investments, Riverside county hospital still shows $15 million shortfall. MS Patient settles pressure Sore Lawsuit Against Home Health Agency for $600,000 Point-of-care wound visioning technology: Reproducibility and accuracy of a wound measurement app. Literature Review

Wound Photography – How it Benefits Clinical Documentation: A visual confirmation to the written record confirms that images: Facilitate better diagnosis Enhance clinical documentation Help to monitor the progress of wound healing Help prevent litigation in wound management Allow inter-disciplinary communication among the wound care team Reduce costs (Wound Care Advisor., 2017) Patient perception of wound photography: Photographic documentation of difficult to see wounds from the perspective of the patient improved patient involvement in the wound care process (Wang et al., 2016). Literature Review Zobair

Root Cause Analysis Inaccurate documentation and lack of supportive documentation during litigation. Not all facilities have equipment. Resistance to change. The inability of the management team to see the importance of wound documentation. Lack of knowledge and lack of most UpToDate evidence based methods Complacency and bureaucracy If adherence is not perceived, The hospital is exposed to regulatory and civil lability L Root Cause Analysis

Lewin’s Change Management Model Z

Lewin’s Change Management Model Communicating with all the stakeholders about the change, which will create a sense of trust and therefore reducing resistance.   Unfreeze - Organization must get prepared for the change Period of actual change including the planning and implementation stages of the project.   Change - change takes place Ongoing support of all stakeholders, with continuing training.    Refreeze - change has been accepted, embraced and implemented by people, the company begins to become stable again. Lewin’s Change Management Model Z

Problem: Current wound documentation is not most accurate and can lead to detriment. H

PDSA: Aim Registered Nurses of RUHS clinics will take pictures of wounds of all patients with Diabetes by June 2019. H

Tasks Person responsible When Where Discuss the benefits of proper wound documentation. Quality and Safety Team. Immediately At meeting with all facilities 2. Present the consequences of improper wound documentation 3. Review the standard protocol for wound documentation All medical personnel. 4. Determine budget and number of cameras needed. Finance, RN’s, and MD’s. Various RUHS sites. H

Measures to determine if prediction succeeds Incidence of pressures ulcers decrease. Review and Analyze wound report monthly Improved assessment of patient by referring back to wound pictures Survey of nurses’ responses and opinion with the incorporation of wound pictures. RNs more accountable to prevent pressure ulcers. Incidence of pressure ulcers after 24 hours from admission Doctors have a better picture of wound and does not have to rely solely on Nurse’s documentation.    Survey and questionnaire of doctors feedback of camera implementation. H

-Educate nurses, nurse Managers, and administrators, get buy-in Introduction of camera Start taking pictures on admission Change becomes permanent L (Monitor the use of the camera ) Reeducate as needed

Prediction Outcome Incidence of pressures ulcers decrease. Pressures ulcer incidence decreased. Improved assessment of patient by referring back to wound pictures Doctors and nurses have mentioned that having a picture to compare with helps to see progression. RNs more accountable to prevent pressure ulcers. The focus has shifted, and RNs feel more pressure to ensure patient is turned Q2 Doctors have a better picture of wound and does not have to rely solely on Nurse’s documentation.   Doctors report getting a more complete picture of what is happening with their patient.   H

Problem Solution Inaccurate documentation Taking pictures to help support RNs documentation.   Lack of supportive documentation during litigation. Having pictures help support RN documentation during litigation.   Summary Pressures ulcer incidence decreased. Doctors and nurses have mentioned that having a picture to compare with helps to see progression. The focus has shifted, and RNs feel more pressure to ensure patient is turned Q2 Doctors report getting a more complete picture of what is happening with their patient.   D

Recommendations Recommendations having extra camera and batteries, in case the primary one goes out. It is also important that not everyone will consent to getting their pictures taken, therefore, documenting as normal without the picture. We also recommend that people having a secondary light source in the event lighting is limited. To prevent injury and take accurate pictures, the nurse should always be accompanied by a helper. If funding is available, it may be appropriate to use a camera phone with an app integrated with the current system.

Stakeholder Analysis Internal stakeholder RN, MD, PA, NP, nurse manager, CEO External Stakeholder Patient, Family, Insurance Companies, Tax payers L

Forcefield Analysis Forces For Forces Against Better Documentation Introduction Of Wound Camera The Cost of Purchasing a Camera Better patient outcome Patient Privacy Accountability of RN Management of the Camera System Evidence for Litigation Contamination of wound Cost saving Resistance to change

References Horseman, J., & Horseman, J. (2018, February 21). After big investments, Riverside County hospital still shows $15 million shortfall. Retrieved from https://www.pe.com/2018/02/20/after-big-investments -riverside-county-hospital-still-shows-15-million-shortfall/  Newman, E. (2018). Photography should be used to document injury, forensic nursing expert says. Retrieved from https://www.mcknights.com/news/photography-should-be-used-to-document-injury-forensic -nursing-expert-says/ Nursing Home Law Center. (2019). MS Patient Settles Pressure Sore Lawsuit Against Home Health Agency for $600,000. Retrieved from https://www.nursinghomelawcenter.org/ms-patient-settles-pressure-sore -lawsuit-against-home-health-age.html  Wang, S. C., Anderson, J. A., Jones, D. V., & Evans, R. (2016). Patient perception of wound photography. International wound journal, 13(3), 326-330. Wang, S. C., Anderson, J. A. E., Evans, R., Woo, K., Beland, B., Sasseville, D., & Moreau, L. (2017). Point-of -care wound visioning technology: Reproducibility and accuracy of a wound measurement app. Plos One, 12(8), e0183139. https://doi.org/10.1371/journal.pone.0183139 Wound Care Advisor. (2017, August 06). Wound Photography – How it Benefits Clinical Documentation. Retrieved from https://woundcareadvisor.com/wound-photography-benefits-clinical -documentation/