1. Pressure Ulcer Collaborative Implementing a Change Process Saint Elizabeth Manor March 10, 2009 1

2. Quality Partners of Rhode Island General Overview of the Project Participated in Wound Collaborative 2003/2004 Initiated many changes that required the support of Administration in time and dollars Goals: Fewer pressure ulcers Increased overall staff awareness 2

3. Quality Partners of Rhode Island Problem or Difficulty the Change Was Designed to Address: 1.The problem simply was to decrease the number of facility acquired pressure ulcers 2. Lack of staff awareness 3. Review currently used devices, assessments, tools and products for effectiveness 3

4. Quality Partners of Rhode Island What are the Significant Results? 1.Decreased the facility acquired pressure ulcers 2.Increased staff awareness 3.Achieved quicker identification of pressure areas and initial treatment 4.Quicker healing times 4

5. Quality Partners of Rhode Island Start

6. Quality Partners of Rhode Island The Steps in Developing the Project 1.Education:for all staff from all departments,residents and family members Kick-off event: Theme was “PUP” Pressure Ulcer Prevention Inservices All staff received a ribbon/bookmark Incentives 6

7. Quality Partners of Rhode Island Practice Success Through Prevention… Skin Care Report Card Report these changes to a nurse: Reddened skin Bluish or purple skin mark Black heel Rashes Denuded or raw skin Skin tears Other unusual conditions

8. Quality Partners of Rhode Island Ten Commandments of Wound Care 1.Thou shall not use donuts or eggcrates 2.Thou shall not use cytotoxic agents in wounds(betadine) 3.Thou shall not massage bony prominences. 4.Thou shall turn residents every 2 hours and use a pull sheet 5.Thou shall observe the 30o rule 6.Thou shall keep heels off the bed 7.Thou shall maintain continence and keep skin dry and moisturized 8.Thou shall keep residents level of functioning intact 9.Thou shall use moist wound healing in the treatment of all wounds 10.Thou shall educate residents and families in wound care. Karen Treloar RN Catholic Memorial Hospital, Fall River, Ma

9. Quality Partners of Rhode Island The Steps in Developing the Project 2.PRODUCTS Smith & Nephew: Barrier cream/EPC cream Skin Report Cards

10. Quality Partners of Rhode Island The Steps in Developing the Project 3.DEVICES Mattresses: Changed to high density foam No egg crates BRIEFS: off at night No Chux Cushions

11. Quality Partners of Rhode Island The Steps in Developing the Project 4.TOOLS Assessment Tool: Braden Pressure Ulcer Healing: PUSH Tool Helping Hands

12. Quality Partners of Rhode Island Hand Sign Room #:______ Device:_______ Resident:______ Signature:_____ Date:__________

13. Quality Partners of Rhode Island 1.Resistance from staff and residents especially regarding briefs 2. Cost increases 3.Time Limitations or Problems Encountered 13

14. Quality Partners of Rhode Island How were you able to overcome the problem? 1.Briefs were gradually eliminated-include C.N.As in the process from the beginning and try one area/corridor at a time. 2. Costs initially increased, but with decrease in pressure area numbers savings increased in both product and staff time. 3. Time commitment: Need time to do education sessions and also use of the time of others to assist: DON/Staff Dev/Unit Managers 14

15. Quality Partners of Rhode Island Partners in the Change process: EVERYONE MUST BUY IN AND HELP! Including: Staff/Residents/Families 15

16. Quality Partners of Rhode Island The Resources, Products and Tools We created an overall sense of awareness by everyone. Awareness became standard practice “We really don’t think about it anymore, we just automatically do it” 16

17. Quality Partners of Rhode Island Advice to Other Organizations Any tips that might help someone who follows in your path 1.Make the commitment-Be willing to initially increase some costs and invest staff time 2.Education leads to awareness. 3.Education is for everyone 4.Monitor your outcomes. 17

18. Quality Partners of Rhode Island Contact Information MaryJean Sylvaria Saint Elizabeth Manor-Bristol 253-2300 Msylvaria@stelizabethcommunity.com 18