1. Skin detectives
Working together to reduce risk for pressure ulcer development
Presented by:
Amy Boge, Audrey Munn, & Sandra Wernstrom

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

3. 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 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.

4. Clinical significance
Pressure ulcers adversely affect quality of life by reducing mobility and increasing pain (National Pressure Ulcer Advisory Panel, 2015).
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).

5. GOALS OBJECTIVES 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
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

6. 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 members with evidence based knowledge and skills.

7. Role of each team member
Administrator Approves budget for equipment and supplies that will reduce pressure ulcer development
CNO Ensures equipment and supplies are available for pressure ulcer prevention
Physician Ensure appropriate treatments are prescribed and adjusted as clinically indicated
Quality Director Ensures that documentation reflects policy and procedures that reflect pressure ulcer prevention

8. Role of each team member
Wound Nurse Implement 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.

9. Role of each team member
RN Ensures 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 manager Ensures that patients are discharged with appropriate recommendations for pressure redistributing mattresses and chair cushions.

10. Role of each team member
Material Manager Ensures supplies and equipment meet patient needs Responsible for managing hospital supplies.
CNA Ensures that each patient is repositioned at least every two hours or per tissue tolerance. Provide incontinence care. Maintain clean and dry skin.
Physical Therapist Help patients improve endurance and mobility
Occupational Therapist Help patients improve independence with ADL’s

11. Role of each team member
Pharmacist Monitors medication that may effect fragile skin
Dietician Collaborates with the physician on patient’s nutritional needs and educates patients.

12. Certified Nurses Assitant
Organizational chart
Physician
Administrator
Case Manager
Pharmacist
Dietician
Wound Nurse
Registered Nurse
Therapist
Certified Nurses Assitant
Chief Nursing Officer
Director of Quality

13. It takes a team
Practice the true profession of nursing where patients matter and your skills are appreciated

14. 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.

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

16. Required Supplies 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

17. Required supplies 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

18. Required supplies 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

19. Required supplies Mepilex Tegaderm foam
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
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

20. Total budget for preventative supplies is: $6,762 per month
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

21. 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: National Pressure Ulcer Advisory Panel. (2015). Quick facts. Retrieved from:

22. References
Spears, M. (2013). Pressure ulcers what are the implications? Lippincott Nursing Center. Retrieved from: &Journal_ID=496448&Issue_ID= 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: /j x