1. "TURN, TURN, TURN" LINDA OSEI NA MONICA JACKSON NA MARK GRANT CNII RN KATHLEEN ROBERTSON CNII RN-BC JULIE PACHECO CNIII RN-BC KATHY PRICHARD CNIV RN-BC 5 ANDERSON SKIN CARE TEAM MAY 2013

2. “EVERY 2 HOURS - TURN, TURN, TURN”

3. “THERE IS A REASON - TURN, TURN, TURN”

4. “ REMEMBER, BEST PRACTICES ALWAYS BEGIN WITH YOU!!” 5 ANDERSON NORTH SKIN AND WOUND RESOURCE NURSE I. Purpose of role a. To serve as a resource, role model, and educator to 5 Anderson staff related to issues of skin, wound and ostomy care. II. Participation responsibilities a. Attend skin and wound resource class/clinical b. Attend 50% of quarterly meetings and communicate via emails c. Each member is responsible for 1 (one) yearly project d. Each member is to participate in the following required activities: -5 Anderson monthly skin audit, housewide quarterly skin survey, audits, and FORUM attendance e. Keeping skin care supply closet stocked f. Complete NDNQI Survey online training yearly with certificate turned in to Carol Benge III. Education resources a. Review minutes, article, and information disseminated by the WONC’s b. Educate 5 Anderson staff on Skin and Wound Resource Nurse role c. Provide educational activities based on unit need regarding skin, wound and/or ostomy care d. Maintain an up-to-date Skin and Wound Resource notebook e. Collaborate at FORUM meetings regarding unit issues, problems, and successes regarding skin, wound, ostomy care. f. Encourage/support 5 Anderson staff in teaching patients and family members regarding skin, wound, and ostomy care OPTIONS FOR EDUCATIONAL ACTIVITIES 1. Provide in-service on 5 Anderson related to skin, wound, and/or ostomy care 2. Develop visual learning aids -story board - bulletin board - article review/pass out an article from the monthly FORUM 3. Develop patient education program 4. Participate in approved CQI project related to skin, wound, and/or ostomy care 5. Participate in revisions to hospital policies related to skin, wound, and/or ostomy care 6. Participate in yearly 5 Anderson Competency Skills Fair at the "Skin Table" 7. Develop and present a WWYD for monthly 5 Anderson staff meeting 8. Report monthly skin survey results at staff meeting 9. Advertise the WOCN website on 5 Anderson/staff meeting 10. Borrow a WOCN poster

5. INSTRUCTIONS FOR TURNING Q2HRS (Patients with Braden Scores <19) Step 1 – Go to “Activities/Interventions” on E-Chart. Step 2 – Document activity level under “Activity.” If we are performing Q2 hour turns, then “Turn Assist” should be checked. Step 3 – Document number needed to assist in next field. Step 4 – In field labeled “Position,” either “Supine,” “Left Lateral,” or “Right Lateral” must be checked in order for the Q2 documentation to be valid. These are the only position changes that show moving from one area of pressure to another. NOTE: You may check other boxes in ADDITION to “Supine,” “Left Lateral,” or “Right Lateral.” For example: You may check “Left Lateral” and “High Fowler” if it applies and this would be acceptable since one of the three positions for position change was documented. “High Fowler” by itself is not acceptable. When a person is in a chair, specialty bed or cardiac chair, the same guidelines apply to positioning and the patient must be moved from one position to another q1hr. When a patient is in a Clinitron bed, we must document turning head from one side to another as well. Please also make sure to document if power on, heel relief on and how many side rails are up. Turns should be documented on the odd hours and performed by the NA. If the NA needs help turning, please contact the RN or 2 nd NA if there is one that day. I, ____________________________, have read and understand the above expectations regarding q2 hour turning. Date :______________________________________________ Signature: _________________________________________ Instructor Signature: ________________________________ 5 Anderson unit wide education to promote a standard for repositioning and documentation. Each staff member was consoled by a chair of the 5 Anderson Skin Committee. Once the information was reviewed by the chair member with the staff member, the form was signed in acknowledgement of understanding and intended compliance. The forms were then turned into the nurse manger. During monthly audits, if a staff member is found non compliant, they receive a written warning and reeducation. Upon their third warning, their name is reported to the nurse manager. “A TIME TO BE TAUGHT, A TIME TO LEARN”

6. “A TIME TO PREVENT, A TIME TO TURN”

7. “A TIME TO BE RIGHT, A TIME TO BE LEFT”

8. “A TIME TO BE SUPINE AND TO DOCUMENT” STEP PAWSITIVELY Poster fostering proper documentation of repositioning and pressure ulcers.

9. “EVERY 2 HOURS - TURN, TURN, TURN THERE IS A REASON - TURN, TURN, TURN REMEMBER, BEST PRACTICES ALWAYS BEGIN WITH YOU!!”

10. “ A TIME TO PROTECT THEIR SKIN”

11. “A TIME TO CLEAN AND MOISTURIZE”

12. “A TIME TO ELEVATE THEIR KNEES AND”

13. “NO MORE THAN HEAD AT 30 DEGREES”

14. “EVERY 2 HOURS - TURN, TURN, TURN THERE IS A REASON - TURN, TURN, TURN REMEMBER, BEST PRACTICES ALWAYS BEGIN WITH YOU!!”

15. “A TIME TO RELIEVE PRESSURE AND FLOAT THEIR HEELS”

16. “A TIME TO OPTIMIZE GOOD NUTRITION”

17. “A TIME YOU MAY EMBRACE” Improving Skin Care Compliance on 5 Anderson- One Good Turn Deserves Another A poster that was submitted for the Quality Expo Fair highlighting the educational initiatives that have been implemented on 5 Anderson for the betterment of our patients skin.

18. PNA Education 5 Anderson unit wide education to promote a standard for repositioning and documentation. When a PNA from another unit or from the staffing office will be sitting with a patient who’s Braden score is <19, the charge nurse has the responsibility to review our policy for repositioning and documentation. Once the information is reviewed by the charge nurse and PNA, the form was signed in acknowledgement of understanding and intended compliance. The forms were then returned to the Skin Care Closet designated notebook where they will be kept for one month. During monthly audits, if the PNA was found non compliant, their manager is notified. “TO EDUCATE, EDUCATE, EDUCATE!”

19. “EVERY 2 HOURS - TURN, TURN, TURN THERE IS A REASON - TURN, TURN, TURN REMEMBER, BEST PRACTICES ALWAYS BEGIN WITH YOU!!”

20. “A TIME TO ASSESS, A TIME TO ACT” Visual aid for nursing staff when a patient presents with a pressure ulcer at time of admission giving the nurse dressing application options according to what stage the pressure ulcer is prior to recommendation from the WOCN. The poster not only shows a picture of the stage of the pressure ulcer but a written description is also included. The options for dressing supplies are both visually shown and described in red. 5 Anderson Skin Supply Closet Maintaining our skin closet to ensure that the latest supplies are available to meet our patient's needs.

21. Q2 TURN DOCUMENTATION AUDIT – SUBSEQUENT WARNING RN/NA Name: _____________________________ Date Audited: _______________________________ Date of Documentation: _______________________ Your patient in Room___________ had a Braden score less than 19. The following was either not completed or only partially completed after an E-Chart Review and Audit of your documentation by the Skin Team. Q2 Turns documented on the odd hour. (0700, 0900, 1100, etc…) Q2 Turns documented within the 2 hour limit. Q2 turning documented while patient in chair or sitting on side of bed. Documentation of Bed Type, if power on, if heel relief on. Attached is a copy of the Q2 turning guidelines for your reference. Please note that this is a second notification of noncompliance with Q2H documentation and this audit will result in consultation with management. Please review the above findings, sign the form and return to Kathy or Julie. A copy of this form will be forwarded the Nurse Manager. Thank you for your compliance. -5 AD Skin Team (Kathy, Julie, Kathleen, Mark, Monica, and Linda O.) RN/NA Signature: ____________________ Date: ______________ Auditor Signature: ______________________ Date: ______________ “A TIME TO AUDIT, A TIME TO REWARD ”

22. “A TIME TO BE INVOLVED, A TIME TO CARE”

23. “ FOR NO PRESSURE ULCERS ANYWHERE, WE SWEAR IT'S NOT TOO LATE!”

24. THANK YOU!