A HAPI Story Carrie Mecikalski, BA, RN, CWON; Wound and Ostomy Nurse & Joe Beiler, MS, RN, ACNS-BC, CNS Froedtert Hospital Wisconsin Association of Clinical Nurse Specialists CNO/CNS/Shared Governance Breakfast September 6th , 2019

Hospital Acquired Pressure Injuries Outlier in quality metrics Multiple causative factors Group which owned pressure injuries had ineffective structure and leadership support Wound program had inconsistent leadership and lacked medical executive Many competing priorities Lack of timely, useful data Lack of QI follow up

The Struggle with Sustainability Skin Care Champions third start Wound program turnover Hospital growth and staff knowledge Over-reliance on WOCN consults to manage skin Inconsistent use and knowledge about products and equipment

PIP Domain Team Executive Support Pressure Injury Prevention Domain Team PIP in Perioperative Services Skin Care Mangement Team ICU Pressure Mapping Trial Other Ad Hoc meetings Quality Oversight Committee Quality and Safety Council

The Players CNO support and guidance Director support Data and report builders WOCNs CNSs Staff Nurses Certified Nursing assistants and Critical Care Techs Shared Governance members Safe Patient Handling team Dieticians Therapy (RT, PT, OT)

Project Description Gap analysis Revamp Best Practice Bundle Re-education – Multi-hospital education module focused on Braden risk mitigation Engage staff Add more structure to PIP Delineation of responsibilities and communication patterns established Engagement of Accountable Care Teams

Resources

Empowering Staff Interactive Skin Care Champion meetings Feedback sessions Engagement in evaluating data and creating PDSA improvements

Re-prioritizing WOCN work Daily Assignment Prioritization: Stoma Markings/Ostomies/Fistulas (New and follow-ups) New Pressure Injuries If deemed to be MASD or POA Stage 1 or 2, notify provider and refer them to the intranet site for appropriate bedside interventions. Follow-up HAPI DTI’s CDI query if noted to be approaching discharge Follow-up HAPI’s New Wound Consults With the exception of orders for Skin Tears – notify provider and refer them to the intranet site for appropriate bedside interventions.

Tools and Equipment Challenge to standardize between different levels of care among 3 settings Skin care products Repositioning devices Skin protectors Working with purchasing to ensure contracts and pricing

Process measures Created an observation tool for PIP best practice bundle Obtained access to a web-based data collection program Had staff collect data and enter it Collected opportunities for improvement Created action plans around those opportunities

Process Measure

Opportunities for Improvement

Data

Continuous Quality Improvement Ongoing education Re-engaging staff in revised process measures Standardizing products and processes Documentation and report challenges

Implications for Nursing Practice Staff were very eager and engaged in quality improvement projects Needed data to understand the problem Needed guidance in the QI process Staff took pride in accomplishments Feedback communication demonstrated that their concerns were heard and action was taken Participation in activities tied to incentive program

Contact Information Carrie Mecikalski BA, RN, CWON Carrie.mecikalski@froedtert.com Inpatient Wound and Ostomy Phone: 414-805-2620   Joe Beiler, MS, RN, ACNS-BC Joseph.beiler@froedtert.com 11CFAC Clinical Nurse Specialist Phone: 414-454-7257