1. Health Management Team
Lowering Pressure Ulcers through Evidence & Process- A spotlight on Gastrointestinal Nursing
Health Management Team
Lavon Beard Yvette Glenn Britt Mcilwain
Daran Brown Cowanda Lawrence Dr. Maria Oquendo
Annie Shedlarski

2. What is a Pressure Ulcer?

3. Background on W7N

4. Impact of Pressure Ulcers on Patient Outcomes
According to a 2012 UCLA study, “seniors who developed pressure ulcers were more likely to die during their hospital stay, to have longer stays in the hospital, and to be readmitted to the hospital within 30 days of their discharge.”
University of California - Los Angeles. October 2, “Hospital bedsores linked to patient mortality” .Journal of the American Geriatrics Society

5. UAB Nursing Pressure Ulcer (PU) Bundle A guideline of best evidence-based practice interventions
Document comprehensive skin assessment
Initiate the Nursing PU Care Protocol if present on admission
Document the Braden score
For Braden score of 17 or less, initiate the Nursing Skin Care Protocol
Document and assess skin on every shift
Prevent Skin breakdown using: Barrier cream/wipes; dressings; body aligners; & Waffle boots
Turn your patient at least every 2 hours
Do NOT over pad the bed
Use slide sheets & Safe Patient Handling Equipment
Education & Nutrition
WOCN Orders And Powernotes
ON ADMISSION
DAILY CARE
PREVENTION
The Pressure Ulcer Prevention Bundle is designed as a guideline of best practice interventions and evidence-based components to be used consistently throughout UABH in pressure ulcer prevention and treatment.
ON ADMISSION
Document if skin intact or not
If not intact, complete admission skin assessment documentation and then document further specifics in IVIEW under the Wound/Ostomy/Drains/Tubes band
If a pressure ulcer is present on admission, then initiate the Nursing Pressure Ulcer Care Protocol
Document the correct Braden score on admission, click on the reference text (Braden Score Component) to view definitions / explanations of score options
If the patient has a Braden score of 17 or less, then initiate the Nursing Skin Care Protocol
DAILY CARE
Document and assess skin on every shift
If Braden score decreases to 17 or less then initiate Nursing Skin Care Protocol
PREVENTION of PRESSURE ULCERS
Use the skin description cards and skin prevention supplies located on the supply carts to prevent skin breakdown
Barrier Cream
Barrier Wipes
Mepilex Dressings
Foam body aligners (wedges)
Waffle boots
Turn your patient at least every 2 hours
Do NOT pad the bed, this leads to an increase in pressure ulcers
Use slide sheets to move patients and prevent skin tears
TREATMENT of PRESSURE ULCERS
If a pressure ulcer develops then initiate the Nursing Pressure Ulcer Care Protocol
Review the WOCN care orders and follow them
Continue the prevention measures listed above
EDUCATION and NUTRITION
Provide education to the patient and family on pressure ulcer prevention and treatment
Have the patient / family watch the Pressure Ulcer Video, video #842 on the TIGR system
Provide the patient and family with a copy of the Pressure Ulcer Prevention education located in Depart of IMPACT
Ensure that the patient is receiving adequate nutrition or nutritional supplements
WOCN ORDERS AND POWERNOTES
Wound care instructions are located under patient care and WOCN Orders in Impact. Please read orders and follow correct wound care instructions. Sign, Date, & Time All Dressings.
WOCN NOTES are located under Reports and Documents-Consults
TREATMENT

6. New Processes on W7N
1. Admission- Double check by two RN’s 2. How do we ensure accountability Management team active participants- 2 audits per quarter. 3. Quality Huddles each shift A. 10am/10pm quality huddles with pressure ulcer focus B. Sheets used to trace patients progress/deterioration
Room #
Name
Status/Injury
Plan
Quality Bundle Equip present
W754
Cri
Healed Sacrum
Q2h turns
W747
Rob
At Risk ?
Q2h turns/WOCN consult
W748
Pet
Stage 1 sacrum
Q3h turns
W742
Wat
At Risk- sacrum
Mepilex- Q2h turns
W736
Lof
R heel non-blanch,
Q2h
Waffle boots
W734
Fos
Purple sacrum/non deep tissue
Waffle/Wedge/Mepilex
W728
Qui
At risk, sutures on bottom
Wedge
W724
McC
At risk
W718
Whi
W716
Hay

7. National Database of Nursing Quality Indicators (NDNQI®)
How do we Measure our Performance? The Dashboard.
National Database of Nursing Quality Indicators (NDNQI®)
The measurement of hospital-acquired pressure ulcers allows organizations to:
Assess the quality of their care;
Evaluate quality improvement initiatives, and;
Examine institutional structures and processes that may influence their occurrence.
Nursing Quality Chair
Oversees the Survey process & Reports results to Hospital & Nursing Quality Councils
WOCN Led Teams
Trained and certified WOCNs
Lead Teams of Trained RN staff
In the collection of NDNQI Data
Data Analyst
Compiles and enters all survey forms into the database

8. Results: NDNQI for W7N HAPU
Success

9. Results: Control Chart for W7N HAPU

10. Recommendations & Next Steps
Is this a Scalable process throughout UAB
Evidence is clear, commitment is the question?
The Hawthorne effect is powerful

11. Discussion