Partnering to Reduce Pressure Ulcers Empire Quality Partnership January 27, 2008

Caring Together: Pressure Sore Improvement Training Program CCLC is an affiliate of the Greater New York Hospital Association

Overview of Caring Together 80 health care organizations –Long term care providers (NHs & HHAs) –Hospitals Joint training across settings –Building a common perspective, vocabulary, and basic understanding Movement toward building partnerships across settings

Terminology Pressure Ulcer (NPUAP) – –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 and/or friction. –A number of contributing or confounding factors are associated with pressure ulcers and are yet to be elucidated. Decubitis Ulcer Bedsore “Pressure Sore” – to recognize the team-based nature of the training

Why do we need to focus on pressure sore improvement?

Percentage of High-Risk Long-Stay Residents Who Have Pressure Sores

Percentage of Low-Risk Long-Stay Residents Who Have Pressure Sores

Percentage of Short-Stay Residents with Pressure Sores

Hospital Picture: Decubitus Ulcers US Hospitals, 2004: NYS Hospitals, 2005: 34.6 NYS Hospitals, 2006: 33.8 Source: The Health Economics and Outcomes Research Institute (THEORI) of GNYHA analysis of risk-adjusted AHRQ Patient Safety Indicators

Perspectives Centers for Medicare and Medicaid Services NYS Department of Health –Bureau of Residential Services –Pay for Performance Quality Improvement Organizations Advancing Excellence in America’s Nursing Homes NYS Office of the Medicaid Inspector General Residents or Patients

Part of the Solution: Pressure Sore Improvement Training NYS Health Workforce Training Initiative (HWRI) –CCLC’s Quality Improvement Consortium Training Programs Focus: improving team-based approach to pressure sore improvement Need for additional collaborative opportunities

Spring 2008 Train-the-Trainer Local Training Tier Four Caring Together: Pressure Sore Improvement CCLC’s Quality Improvement Consortium (QIC) Training Program Spring 2008 through Winter 2009

Engaging the Hospital Community Curriculum development Announcement through GNYHA’s hospital quality channels Invitation to partner through CCLC’s long term care members Attend trainer workshops together Ongoing communication & local training

CCLC Pressure Sore Improvement Training Program Table of Contents Module 1: Prevention Module 2: Assessment Module 3: Treatment Module 4: Documentation Module 5: Regulatory Aspects of Wounds & Risk Management Module 6: Leadership and Team Building Resources

Timeline Development of curriculum, 2007 January 2008: Pilot training March 17: Executive Briefing March 24: First train the trainer workshop –Through May/June 2008 Local training at member organizations –Through Winter 2009 Ongoing coordination with CCLC & QISN –Development of standard measurement tool –Identification of deeper clinical education needs –Assistance with partner relationships

St. Elizabeth Ann’s Health Care and Rehabilitation Center – SVCMC 300-bed facility on Staten Island Specialty populations - ventilator, HIV/AIDS, neurobehavioral, subacute Challenges and opportunities for pressure sore improvement Experience with training collaborative Next steps

Village Care of New York VCNY nursing homes –Village Nursing Home: 200-bed going through significant changes –Rivington House: 206-bed HIV/AIDS Challenges and opportunities for pressure sore improvement Experience with training collaborative Next steps

Next Steps Standardized tracking tool Assistance with hospital partnerships Additional and targeted training