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A HAPI Story Carrie Mecikalski, BA, RN, CWON; Wound and Ostomy Nurse & Joe Beiler, MS, RN, ACNS-BC, CNS Froedtert Hospital Wisconsin Association of Clinical Nurse Specialists CNO/CNS/Shared Governance Breakfast September 6th , 2019
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Hospital Acquired Pressure Injuries
Outlier in quality metrics Multiple causative factors Group which owned pressure injuries had ineffective structure and leadership support Wound program had inconsistent leadership and lacked medical executive Many competing priorities Lack of timely, useful data Lack of QI follow up
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The Struggle with Sustainability
Skin Care Champions third start Wound program turnover Hospital growth and staff knowledge Over-reliance on WOCN consults to manage skin Inconsistent use and knowledge about products and equipment
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PIP Domain Team Executive Support
Pressure Injury Prevention Domain Team PIP in Perioperative Services Skin Care Mangement Team ICU Pressure Mapping Trial Other Ad Hoc meetings Quality Oversight Committee Quality and Safety Council
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The Players CNO support and guidance Director support
Data and report builders WOCNs CNSs Staff Nurses Certified Nursing assistants and Critical Care Techs Shared Governance members Safe Patient Handling team Dieticians Therapy (RT, PT, OT)
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Project Description Gap analysis Revamp Best Practice Bundle
Re-education – Multi-hospital education module focused on Braden risk mitigation Engage staff Add more structure to PIP Delineation of responsibilities and communication patterns established Engagement of Accountable Care Teams
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Resources
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Empowering Staff Interactive Skin Care Champion meetings
Feedback sessions Engagement in evaluating data and creating PDSA improvements
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Re-prioritizing WOCN work
Daily Assignment Prioritization: Stoma Markings/Ostomies/Fistulas (New and follow-ups) New Pressure Injuries If deemed to be MASD or POA Stage 1 or 2, notify provider and refer them to the intranet site for appropriate bedside interventions. Follow-up HAPI DTI’s CDI query if noted to be approaching discharge Follow-up HAPI’s New Wound Consults With the exception of orders for Skin Tears – notify provider and refer them to the intranet site for appropriate bedside interventions.
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Tools and Equipment Challenge to standardize between different levels of care among 3 settings Skin care products Repositioning devices Skin protectors Working with purchasing to ensure contracts and pricing
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Process measures Created an observation tool for PIP best practice bundle Obtained access to a web-based data collection program Had staff collect data and enter it Collected opportunities for improvement Created action plans around those opportunities
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Process Measure
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Opportunities for Improvement
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Data
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Continuous Quality Improvement
Ongoing education Re-engaging staff in revised process measures Standardizing products and processes Documentation and report challenges
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Implications for Nursing Practice
Staff were very eager and engaged in quality improvement projects Needed data to understand the problem Needed guidance in the QI process Staff took pride in accomplishments Feedback communication demonstrated that their concerns were heard and action was taken Participation in activities tied to incentive program
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Contact Information Carrie Mecikalski BA, RN, CWON Inpatient Wound and Ostomy Phone: Joe Beiler, MS, RN, ACNS-BC 11CFAC Clinical Nurse Specialist Phone:
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