2. SKIN DETECTIVES Working together to reduce risk for pressure ulcer development Presented by: Amy Boge, Audrey Munn, & Sandra Wernstrom

3. OBJECTIVES Mission and philosophy of Skin Detectives Mission and philosophy of Skin Detectives Clinical importance for reducing Hospital Acquired Pressure Ulcers (HAPU) Clinical importance for reducing Hospital Acquired Pressure Ulcers (HAPU) Defining organizational goals and objectives Defining organizational goals and objectives Reviewing team members role in reducing risk factors that contribute to the development of pressure ulcers Reviewing team members role in reducing risk factors that contribute to the development of pressure ulcers Job description for wound prevention champions Job description for wound prevention champions Budget Budget

4. MISSION STATEMENT Skin Detectives promotes skin integrity for all individuals through quality skin care, consistent surveillance, and commitment to preventative care. Skin Detectives is dedicated to reducing risk factors that contribute to pressure ulcer development by initiating individualized care plans, and educating caregivers on prevention plan. PHILOSOPHY Providing effective, efficient, and affordable care to all individuals with special attention to skin integrity.

5. CLINICAL SIGNIFICANCE Pressure ulcers adversely affect quality of life by reducing mobility and increasing pain (National Pressure Ulcer Advisory Panel, 2015). Pressure ulcers adversely affect quality of life by reducing mobility and increasing pain (National Pressure Ulcer Advisory Panel, 2015). Increase risk for mortality ( Increase risk for mortality (Zarathiewicz, Whitney, Lowe, Taylor, O’Donnell, Minton- Foltz, 2011). Impact the economy (Brem, Maggi, Nierman, Rolinitzky, Bell, Rennert, Goliko…Vlandeck, 2011). Florence Nightingale stated that pressure ulcer development was not the fault of the disease, but the fault of nursing (Spear, 2013).

6. GOALS Zero Hospital Acquired Pressure Ulcers Ensure risk factors for skin breakdown are identified upon admission Ensure prevention plan is initiated upon admission RN assesses skin every shift and reports altered skin integrity to the physician Ensure orthotic and respiratory devices fit properly Ensure documentation is completed timely and per agency policy OBJECTIVES Educate Registered Nurses on how to complete a thorough skin assessment Ensure Registered Nurses understand how to complete a BRADEN ASSESSMENT Educate Registered Nurses on preventative care plans Educate Caregivers on proper fit for orthotic and respiratory devices Educate Caregivers on weight redistribution Ensure Chief Nursing Officer and Wound Nurse completes audits on documentation

7. JOB DESCRIPTION Pressure ulcer prevention requires a multi-disciplinary team approach. COLLABORATION between intradisciplinary team members increases the success of a wound prevention program. Each team member plays a key role in wound prevention. The objective of the wound prevention program is to eliminate weak links by empowering each team member with evidence based knowledge and skills.

8. ROLE OF EACH TEAM MEMBER AdministratorApproves budget for equipment and supplies that will reduce pressure ulcer development AdministratorApproves budget for equipment and supplies that will reduce pressure ulcer development CNOEnsures equipment and supplies are available for pressure ulcer prevention CNOEnsures equipment and supplies are available for pressure ulcer prevention Physician Ensure appropriate treatments are prescribed and adjusted as clinically indicated Physician Ensure appropriate treatments are prescribed and adjusted as clinically indicated Quality DirectorEnsures that documentation reflects policy and procedures that reflect pressure ulcer prevention Quality DirectorEnsures that documentation reflects policy and procedures that reflect pressure ulcer prevention

9. ROLE OF EACH TEAM MEMBER Wound NurseImplement policies and procedures that prevent pressure ulcers. Ensures each caregiver understands prevention strategies and proper documentation. Ensures that all patients have supportive surfaces. Collaborates with physicians. Updates BRADEN SCALES weekly and adjusts strategy plans as clinically indicated. Wound NurseImplement policies and procedures that prevent pressure ulcers. Ensures each caregiver understands prevention strategies and proper documentation. Ensures that all patients have supportive surfaces. Collaborates with physicians. Updates BRADEN SCALES weekly and adjusts strategy plans as clinically indicated.

10. ROLE OF EACH TEAM MEMBER RNEnsures that patients are repositioned at least every two hours, or per tissue tolerance. Ensures that patient’s skin is clean and dry. Delegate tasks to appropriate personnel. Ensure supportive surface is in place. Document preventative care. Report skin alteration to physician. RNEnsures that patients are repositioned at least every two hours, or per tissue tolerance. Ensures that patient’s skin is clean and dry. Delegate tasks to appropriate personnel. Ensure supportive surface is in place. Document preventative care. Report skin alteration to physician. Case managerEnsures that patients are discharged with appropriate recommendations for pressure redistributing mattresses and chair cushions. Case managerEnsures that patients are discharged with appropriate recommendations for pressure redistributing mattresses and chair cushions.

11. ROLE OF EACH TEAM MEMBER Material ManagerEnsures supplies and equipment meet patient needs. Responsible for managing hospital supplies. Material ManagerEnsures supplies and equipment meet patient needs. Responsible for managing hospital supplies. CNAEnsures that each patient is repositioned at least every two hours or per tissue tolerance. Provide incontinence care. Maintain clean and dry skin. CNAEnsures that each patient is repositioned at least every two hours or per tissue tolerance. Provide incontinence care. Maintain clean and dry skin. Physical TherapistHelp patients improve endurance and mobility Physical TherapistHelp patients improve endurance and mobility Occupational TherapistHelp patients improve independence with ADL’s Occupational TherapistHelp patients improve independence with ADL’s

12. ROLE OF EACH TEAM MEMBER PharmacistMonitors medication that may effect fragile skin PharmacistMonitors medication that may effect fragile skin DieticianCollaborates with the physician on patient’s nutritional needs and educates patients. DieticianCollaborates with the physician on patient’s nutritional needs and educates patients.

13. ORGANIZATIONAL CHART PhysicianAdministrator Case Manager PharmacistDieticianWound Nurse Registered Nurse Therapist Certified Nurses Assitant Chief Nursing Officer Director of Quality

14. IT TAKES A TEAM Practice the true profession of nursing where patients matter and your skills are appreciated

15. SKIN DETECTIVES Care for patients with complex medical conditions, which require expert care from nurses who are passionate about wound prevention. We are currently seeking team members who are equally passionate about wound prevention. We offer excellent wound prevention strategies, an environment dedicated to exceptional patient care, and opportunities for academic advancement.

16. RESPONSIBILITIES Deliver quality preventative care Deliver quality preventative care Collaborates with intradisciplinary team members Collaborates with intradisciplinary team members Coordinates mobility program Coordinates mobility program Maintains excellent documentation Maintains excellent documentation

17. REQUIRED SUPPLIES Low-air loss mattress Low-air loss mattress  Redistributes weight while in bed  Reduce friction while repositioning  Wicks away moisture  Indicated for patients who score less than 18 on the BRADEN assessment  Rental cost is $7 per day, with an average of 20 mattresses on the unit per day

18. REQUIRED SUPPLIES Two inch foam seat cushion Two inch foam seat cushion  Reduces pressure to sitting bones  Assigned to all patients  Cushions are not chargeable and will cost the hospital $20 per cushion  Average of 30 cushions per month issued to patients

19. REQUIRED SUPPLIES Z-flex boots Z-flex boots  Reduces pressure to the heels for patients who do not tolerate off- loading  Reduce risk for foot drop  Each boot is $58  An average of 30 boots are assigned to patients per month

20. REQUIRED SUPPLIES Mepilex Mepilex  Reduces pressure and friction to boney prominence  A box of 5 Mepilex 4x4 cost $28  A box of 5 Mepilex Sacral cost $59  Average of two boxes of Mepilex 4x4 and two boxes of Mepilex sacral is used per month Tegaderm foam  Reduce pressure and friction to heels and elbows  A box of 10 Tegaderm foam is $48  An average of one box is used per month

21. PROPOSED BUDGET Total budget for preventative supplies is: $6,762 per month AD COST Journal of Professional Nursing  Full page add  $2,238 per issue Local paper add  One column inch  $48 for three days

22. REFERENCES Brem, H., Maggi, J., Nierman, D., Rolinitzky, L., Bell, D., Rennert, R., Goliko, M.…Vlandeck, B. (2011). High cost of stage IV pressure ulcers. US National Library of Medicine National Institute of Health. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950802/ National Pressure Ulcer Advisory Panel. (2015). Quick facts. Retrieved from: http://www.npuap.org/ http://www.npuap.org/

23. REFERENCES Spears, M. (2013). Pressure ulcers what are the implications? Lippincott Nursing Center. Retrieved from: http://www.nursingcenter.com/CEArticle?an=00006527- 201307000-00012&Journal_ID=496448&Issue_ID=1606087 Zarathiewicz, S., Whtney, J., Lowe, J., Taylor, S., O’Donnell, F., Minton-Foltz, P. (2011). Development and implementation of hospital acquired pressure ulcer incident tracking system and algorithm. US National Library of Medicine National Institute of Health. Doi: 10.1111/j.1945-1474.2010.00076x