Pressure Ulcer Prevention An Interdisciplinary Approach Vancouver Coastal Health - Richmond Pressure Ulcer Prevention An Interdisciplinary Approach BCPSQC Quality Forum 2015 Lisa Stewart Maria Torres

Disclosure Statement Both presenters are employees of Vancouver Coastal Health and declare no potential conflicts of interest.

International NPUAP-EPUAP Pressure Ulcer Definition “A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear…” National/European Pressure ulcer Advisory Panel

(do we need to be concerned about pressure ulcers?) Why? (do we need to be concerned about pressure ulcers?)

Pressure ulcers can develop in less than 12 hours

Prevention is better than treatment

Pressure ulcers have a significant impact on quality of life.

Prevention Strategies = Pressure Ulcers = Quality of Care

Our Strategy

Innovative Respectful Sustainable

evaluated current state Act Plan Do Study evaluated current state identified resources developed the project plan

Current competency level

challenge status quo

Pressure Ulcer Risk Scale completed by the interdisciplinary team at R-Care Challenged current practice adding to the complexity of the change

Why? (in team rounds?)

Pressure Ulcer risk assessment and care planning is interdisciplinary Activity Moisture Mobility Sensory Perception Nutrition Pressure Ulcer risk assessment and care planning is interdisciplinary Hydration Friction & Sheer Lab Values Medical History 1makes sense to bring to interdisciplinary team discussion Medical Status Comorbidities BMI Age

…how does this apply to my practice We need team members thinking

collaboration

Promotes Awareness within the Interdisciplinary Team 2. We need all disciplines thinking about PUP in their practice

Supports Pressure Ulcer Prevention as part of the team’s standard work 3 sustainability

sustainability DO NOT STOP

shared work 4not about distribution of task. It is about bringing people together to reach a higher level of care. It started as a creative solution that led to positive outcomes that result from a shared goal

The whole is greater than the sum of its parts - Aristotle

Utilization of health discipline expertise 5

Can the interdisciplinary team efficiently complete the Braden Scale?

Can the interdisciplinary team accurately complete the Braden Scale?

Comparison of Total Braden Scale Score - Interdisciplinary Team and WOCN

Comparison of Braden Scale Score - Interdisciplinary Team and WOCN Average score variation by subscale Average 0.3

√

Pressure Ulcer Prevention Best Practice Mention all 3

… 5 weeks later Challenge was time and competing priorities

Richmond Hospital Pressure Ulcer Prevention Accreditation Standards Met

Measurement

Patients With a Completed Pressure Ulcer Risk Screen (%) Chart Audit Results Richmond Hospital Patients With a Completed Pressure Ulcer Risk Screen (%)

2014 Average 97.3%

Prevalence & Incidence

What we asked for… Ask - Snapshot of PU on the unit (each month) with criteria Method was unit choice

we got more than we asked for…

teams talking team pride team ownership

Pressure Ulcers February 2015 No Incident Incident

Are we identifying and communicating the risk of a developing pressure ulcer Can we see it coming?

“The process is great for allowing you to very quickly visually note the problem areas for that particular patient ultimately allowing you to prevent sores from progressing”  

“Although we all know the key boney areas of the body most at risk, every patient is different. This form allows for patient centered documentation and prioritization of your care strategies and goals”

“Having a designated location and a standardized way of documentation/communication assures us that patients have their pressure ulcer risks addressed every single day”

“It makes you really think about and consider the high risk skin areas “It makes you really think about and consider the high risk skin areas. It also allows the nurse to see what areas may be of concern specific to that patient and concentrate on their assessment and care before they progress”

“It is a good tool in that it allows you to see immediately when there has been a change in a patients skin condition”

Pressure Ulcer Prevention in the Operating Room

What? Did we learn… Be dynamic Be present Listen Say thank you Dynamic – leadership (lead, direct, facilitate) and flexible in thought Say thank you

Thank you

“Around here, however, we don’t look backwards for very long “Around here, however, we don’t look backwards for very long. We keep moving forward, opening up new doors and doing new things…and curiosity keeps leading us down new paths” - Walt Disney