1. Habersham Medical Center Tallulah Falls Community Group For Regional Two/B

2.   Acute Care Hospital Licensed for 53 Beds.  Long Term Care for 84 Residents  HCMC Home Health Agency  Six Physician Practice Offices  Community Wellness Program Habersham Medical Center

4.   Habersham Medical Center’s mission is to provide high quality caring a compassionate, professional and economical manner to all persons in Habersham County and adjacent areas. Mission Statement

5.   Acknowledging We Had A Problem In the beginning…

6.   Pressure ulcers painful  Increase length of stay  Increase secondary risks of infections  Increases mortality rates  Over 600,000 deaths as a result of complications of pressure ulcers Reality Is…

7.   Data did not reflect a need to focus on pressure ulcer prevention.  Identified physician documentation did not routinely include skin assessments and findings.  Available data came from coding from physician documentation only.  Formulated a multidisciplinary Wound Care Team.  Hosted our Tallulah Falls Community meeting with GMCF to address community pressure ulcers. Listened to our Community

8.   Met our neighbors to put a face with a name.  Shared preventive measure ideas.  Show and tell for preventive and treatment supplies.  Rep demo tables with available products.  Provide one number to call for all concerns for new admissions that came from HMC. Tallulah Fall Meeting

9.   This one step was the one step we took that really made a difference.  Gave us real data on pressure ulcers.  Gave HMC real time information to review the patient’s care to see what we could have done differently.  Learned from our lost opportunities.  Peer pressure knowing that everyone was looking, reporting, and reviewing. One Phone Number 706-754-3113 Ext: 1121

10.   Physical Therapy  Acute Care Nursing (Med/Surg, ICU, OR)  Material Management  Infection Prevention  Information Technology  Long Term Care Nursing  Home Health Administration  Hospital Administration  Medical Staff to include:  Orthopedics & General Surgery Formulated Our Team

11.   Infection Prevention and Material Management leaders took inventory of all skin prevention and treatment products stocked for all areas.  Reviewed our contracted options.  Contracted companies and trialed products in LTC.  Completed cost analysis on products; contract vs. non contract products.  Approved products and educated staff and Medical Staff. Started In The Basement…

13.  Describe your first (or next) test of change Person Responsible When to be done Where to be done 1. Evaluate current products available and newer products on contract for potential use. Infection Prevention & Material Management August 2009 Material Management Department GOAL- Evaluate Products  Step One…

14.  List the tasks needed to set up this test of change Person Responsible When to be done Where to be done 1. Schedule time to meet together 2. Collect all skin products and assign to the GHA PUP Team 3. Contact Company for Product Review 4. Complete cost analysis for preferred products requested. 5. Present cost analysis to Administration for approval. 6.Take approval products to Wound Care Team with Names and Indications IP MMT IP MMT End of week 1 August 20 th September 1 st September 8 th September 10th Via Outlook Department Education/MMT IP Administration Wound Care Mtg. in September ‘09 Step Two

15.  Predict what will happen when the test is carried out Measures to determine if prediction succeeds 1. LTC would reduce pressure ulceration with a non-contract product 2. Education on all stocked products 3. Medical Staff would need to be educated on products. 1. LTC monitored pressure ulcers with the “butt cream” vs. other product. 2. Completed Library on Skin Products with all Products, Indications, and “How To Use” Instructions was a win for staff satisfaction. 3. Presentation to Medical Staff on products and how to located information on products. Step Three

16.   DO:  Describe what actually happened when you ran the test of change.  Clear understanding of products stocked and how to use them.  Medical Staff educated for the need of documentation for pressure ulcers overall, to include POA.  Medical Staff educated on products stocked and how to use them.  Trialed different heel boots with no success. Step Four

17.   STUDY:  Describe the measured results and how they compare to the predicted results.  Staff accepted the change of culture and appreciated the team clearing the confusion related to products.  Medical Staff struggled with the culture change focusing on skin and the importance of documentation and assuring the proper products were being used on the patients.  Unexpected barrier with “Boots” to protect the heels. Trials multiple products that took 18 months to finalize the preferred product. Step Five

18.   ACT-  Describe what changes to the plan will be made for the next cycle from what you learned  Continue to monitor or someone will change it without you knowing it…  Set expectations and follow them closely.  Share the responsibility so all team members are engaged.  It is not what you expect as much as what you inspect. Step Six

19.  Products was just one change

20.  Continue to monitor outcomes until you find your facilities solution

21.   Tallulah Falls Community Meeting  Braden Scale  Staging of ulcerations  Flow chart different terminology of ulceration  Understanding why certain facilities use different scales and terms. Community Skin Evaluation Assessment

22.  Talking the same talk! Skin Tear FrictionInjury Stage II Pressure Ulcer Partial Thickness Burn

23.   Long Term Care implemented weekly Wound Rounds to include Nursing, Physical Therapy, and Medical Staff.  Implemented Acute Care Wound Rounds-  Started small on one unit, Surgical Unit one day a week at the same time with PT and Nursing  Added ICU to Wound Rounds on Wednesday mornings at 0800.  Graduated to doing Wound Rounds weekly on all units. Wound Rounds

24.   Annual wound education for all clinical staff.  Demonstrate products and evaluate the staffs knowledge of proper use.  Creative games using scavenger hunt approach.  Convetec and Medline Reps available to answer questions for products.  Chained wound booklets to each nursing area as a reference  Provided Pressure Point Pocket Cards from GMCF Wound Education

25.   Remembering to stick to the basics before progressing is difficult. We always want to fix everything at once.  Remember time is on your side…  How did our Long Term Care facilities get to zero doing the same things Acute Care is doing? Sometimes the problem is bigger than you can fix!

26.  Get them out of bed!

27.   Don’t assume they know what you need.  Make sure they understand the financial impact and most importantly the impact it has on the patient’s outcome.  Replaced chairs in patient rooms.  Replaced mattresses and beds. Administrative Involvement

28.   Hourly Rounding.  Annual Nursing Tech Education to include pressure ulcer prevention.  Wound Vac Certification for Nursing.  Adding POA to our morning rounds with Medical Staff.  Revised documentation in Meditech 6.0 for Wounds  Deleted all TED Hose facility wide. In addition

29.   The CMS (Centers for Medicare & Medicaid Services) estimates the cost of treating a pressure ulcer case at $43,180.  More than 50% of those costs are in nursing time,  Approximately 39% of the costs are pharmaceuticals  11% are in products. $$$$- SAVINGS-$$$$

30.   Reducing the number of potential pressure ulcers from six (8) to (0) zero over a time span,  We had in fact saved the hospital $330,400 (the number of pressure ulcers reduced multiplied by the average cost to treat one, $41,300, as calculated by CMS). Success

31.   HMC has eliminated HAC Pressure Ulcerations for nine months.  Evaluate documentation and preventive measures taken on each call received from community.  Use information to continued education.  Provide referred facilities with review findings.  Take the time and opportunity to learn from your reviews. In conclusion…

32.  The End