1. Welcome to Georgia HEN Hospital Acquired Condition September Affinity Call September 18, 2013

2. Julie Apold Julie Apold is the Sr. Director of Patient Safety at the Minnesota Hospital Association (MHA) where she has worked with hospitals on patient safety and quality activities for the past 9 years. She collaborates with the Minnesota Department of Health to support Minnesota Adverse Health Event Reporting Law activities; manages the adverse event reporting registry; works with hospitals to provide guidance on fulfilling reporting requirements and analyzing events for trends, safety alerts, and improvement opportunities. Julie is currently managing five state-wide collaboratives to address the top reported adverse event categories – Pressure Ulcers, Surgical Safety, Retained Objects, and Falls.

3. Place picture here Safe Skin: A Roadmap for Pressure Ulcer Prevention Julie Apold Director of Patient Safety Minnesota Hospital Association September 18, 2013

4. SAFE Skin S =Skin safety coordination A =Accurate and concurrent reporting F =Facility expectations, staff education E =Education for patients and families S =Skin inspection and risk assessment K =Keep pressure off I =Incontinence N =Nutrition is optimized

6. SAFE Skin Components  Baseline audit using SAFE SKIN  Action Plan based on gaps  Quarterly SAFE SKIN Updates  Concurrent Pressure Ulcer Rate Reporting Stages II – Unstageable  Quarterly Webinars  Pressure Ulcer Advisory Group Consensus-based action

7. Progress on Calls to Action

8. Continuous Learning  New Pressure Ulcer Learnings: 13% related to surgical procedures 44% device-related o Respiratory equipment; immobilizers 35% patient condition prohibited shift 19% patient refused repositioning o Most common reason – patient preference 61% occur in ICU o 53% backside; 23% occiput

9. Recommendation/Guidance

10. ICU

11. SAFE Skin Highlights  Safe Skin 2.0 Highlights device-related pressure ulcers Strategies for high-risk, complex patients Consistent application of the basics o Conducting a thorough skin inspection o Keep patients moving

12. SAFE Skin 2.0 Roadmap  Roadmap contains 115 questions Additional Gap Analysis Questions

13. PSI 3

14. Concurrent Reporting

15. Key Learnings  Engage the full team Including RT, OR and Patient/Family  Keep patients moving!! There are very few patients that cannot be shifted to some degree  Appropriate surface ASAP  Devices, Devices, Devices  Prior to Safe Skin – Priority = Save the Patient  Now - We can save the patient and their skin!

16. Save Our Skin  Recognizes Skin Teams that “saved the skin” of a complex patient that likely would have developed a pressure ulcer.

17. SOS Stories  Patient remained hospitalized for 20 months. Outlined plan for frequent repositioning Frequently checking bony prominences for signs of skin breakdown Consistent core group of nurses Consistent and frequent site cares *0 skin related issues*

18. SOS Stories  Patient in ICU for 2 months. Small shifts of change every 15 minutes Skin inspection every 2 hours (or more if any areas noted for redness) Body diagram document and detailed shift to shift report addressing skin Continuity of care *0 skin related issues*

19. Questions?