1. Orthopedic / Device Related Nosocomial Wounds SCAHQ Meeting May 14, 2010

2. Introduction - 2006  Observed an increase in wounds related to medical devices in post-op hip and knee patients

3. Devices used on patients with nosocomial wounds  Immobilizer  Ace wrap  Plexi-pulse  Multipodus boot  TED hose  Heel protector  Bucks traction

4. Cause for concern 5 TKA 2 Other 5 TKA 2 Hip 2 Other 7 TKA 5 Hip 2 Femur

5. Action Plan - June 2006  Hip/knee protocol Turn Schedule Patient helper (trapeze bar) Foot/heel assessment Patients seen by Wound Care nurses within 72 hours of surgery Continue wound care visits until transferred to SSCP or ARU or discharge

6. Results of Initial Action Plan

7. Wounds by procedure - 2007

8. Process Improvement – Change to Trigger Tool  Wound Care nurses realized patients with femur fractures were not evaluated  In March, the trigger tool was changed to include femur fractures  Surgical schedule also being checked for surgical procedures; wound care nurses then have opportunity to assess patient

9. Study of results July: Action Plan Implemented

10. July: Action Plan implemented March: Trigger revision Nosocomial Wounds 5 TKA 2 Other 5 TKA 2 Hip 2 Other 7 TKA 5 Hip 2 Femur 0 TKA 1 Hip 1 Femur 1 TKA 3 Hip 4 Femur 1 Tibia 1 TKA 3 Hip 1 Femur 1 THR 2 Hip 1 Ankle 1 Femur 2 TKA 2 Hip 1 Hip 1 TKA 2 Hip

11. Actions Taken  Education of nursing staff  Joint Camp Patient education provided on wound survelance Expect visit from wound care nurse  Patients evaluated within 72 hours Revision of trigger to capture femur fractures Check surgery schedule

12. Results * Nosocomial wounds/patients seen by wound care nurses

13. All Nosocomial Wounds 2006 - 2009 Comparison

14. Consults vs. Admissions consults198239249270315317319312352342387355356382397341405 admissions32233000301731663257306833073062259026042630252024832457241725042635

15. Never Events  Apparent Cause Meeting All Stage III and IV nosocomial pressure ulcers Occurrence reports completed by wound care nurses

16. Nosocomial Wound Rate Wound rate = # Patients/# patient days x 1000

17. New cause for concern?  Increase in nosocomial wounds Unknown causes at this point Do not feel it is due to lack of education  Competency Fair  Staff Meetings  Next Steps National trend in increase of nosocomial wounds in ICU  Patients sicker when admitted?  More multi-system organ failure?

18. QUESTIONS?