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Innovations to Stop Pressure Ulcers among Patients at

Critically High Risk for Pressure Ulcer Development

– a Multidisciplinary Approach

JANUARY 14, 2016

www.goldstamp.org

Webinar Producer

Sue BrooksOnline Production AssistantWeb Page ManagerExpert Synchronous Webinar Producer

Webinar Guidelines 1 hour presentation including a

discussion period at the end.

Send your questions at any time during the presentation via the chat box on your screen.

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Webinar Guidelines

This webinar will be recorded and available ‘on demand’ for future viewing. www.goldstamp.org

Turn on your computer speakers for sound

Handouts are available to download: Right side of your screen www.goldstamp.org

Continuing Education Credits

CNE’s, CME’s and CHES : Please complete the post test and evaluation on

www.goldstamp.org The School of Public Health, University at Albany is an approved provider of continuing nurse

education by the. American Nurses Association Massachusetts (ANA MASS), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

This offering is approved for 1 nursing contact hour.

The School of Public Health, University at Albany is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians.

The School of Public Health, University at Albany designates this live activity for a maximum of 1 AMA PRA Category 1 CreditsTM . Physicians should claim credit commensurate with the extent of their participation in the activity.

Sponsored by the School of Public Health, University at Albany, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to .5 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 0.

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There is no commercial interest funding this program.

The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.

Objectives

Identify three best practices to prevent pressure ulcers in patients at highest risk.

Describe one strategy for involving various interdisciplinary team members in a pressure ulcer prevention collaboration.

Recognize innovative pressure ulcer prevention actions which can be replicated in different settings.

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Speakers 7Marci Ruediger, PT, M.S.mruediger@mageerehab.org215.587.3454

Julie Rece, MSN, RN, CRRN, CWOCNjrece@mageerehab.org215.587.3432

Amy Bratta,. PT, DPTabratta@mageerehab.org215.587.3218

96 Bed Inpatient Acute Rehab Hospital

8About Magee

9About Magee

Outpatient Satellite Clinics

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How we got started 10

Baseline efforts Strong collaboration -

wound care and nutrition

High quality tube-feeding supplements

Advanced seating capabilities

Everyone turned and shifted

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Nursing-Specific Actions

Head to toe assessment by RN, WOCN, MD

Head of bed Weekly full body

assessment with photos

Shift of WOCN hours

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WOC Team

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Barriers for Skin Protection

Foam

Ointments

pH balanced skin cleanser

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Supplies

Liberal use of barriers - protect intact skin exposed to stool

Elimination of plastic from bed pads and briefs

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Nursing-Specific Communication

Staff education Wound care

formulary Supply

guidelines

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Equipment 16

Nutrition 17 Assess for malnutrition on

admission and initiate support

Meet at least 80% of protein needs

Use tube feeding formulas with liquid modular proteins as needed

WOCNs and RDs communicate throughout the day

Poop in a Group 18

PhysicianWOCN

Front-line nurse –BI/stroke

Therapy Seating Specialist

Pharmacy Director

Nurse manager -SCI

Nutrition

Nursing supervisor General Rehab

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Physician-Specific Actions

Physician champion

Assess skin at admission

Engage nursing assistants

Work with WOCN to identify and stage ulcers

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Therapy Innovations 20

Therapy Innovations 21

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Interdisciplinary Innovations 22

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Skin Peers 24

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Leadership 25

Collaboration with other providers

Bracelets for transported patients Brain-storming with providers from

a cardio-thoracic ICU PA Hospital Engagement Network

3 - year collaborative

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Culture Change

Moisture dermatitis as “stage 0”

Sense of urgency related to prevention of skin breakdown

Principles of Just Culture applied

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Results to Date

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

FY 12 FY 13 FY 14 FY 15

Serious Pressure Ulcers per 1000 Patient Days

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Why did it take so long? 29

The Challenge of Wicked Problems

New challenges with devices

Staff turn-over

New patient challenges

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Replication of Process

Interdisciplinary work

Iterative process

Innovation –creating solutions

Not accepting failure

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Lessons We Learn Again and Again

Leadership and accountability matter

Without these - > much work and no improvement

Things get “unfixed” without constant vigilance.

“Over-communication” is a necessity.

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Having Fun While Raising Awareness

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References Carson, D, Emmons K, Falone W, and Preston AM.

Development of Pressure Ulcer Program across a University Health System. J Nurs Care Qual. 2011; Vol. 00, No. 00, pp. 1-8.

Coleman S, Nixon J, Keen J, et al. A New Pressure Ulcer Conceptual Framework. Journal of Advanced Nursing. 2014; 70(10), 2222-2234.

Cox, J., and L. Rasmussen. "Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients." Critical Care Nurse 34.6 (2014): 15-27. Web.

DeJong G, Hsieh CJ, et al. Factors Associated with Pressure Ulcer Risk in Spinal Cord Injury Rehabilitation. Am J Phys Med Rehabil 2014; 00:1-16.

Edsberg LE, Langemo D, Baharestani MM, et al. Unavoidable Pressure Injury: State of the Science and Consensus Outcomes. J Wound Ostomy Continence Nurs. 2014; 41 (4): 313-334.

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References (continued) Hoffer, L. J., and B. R. Bistrian. "Appropriate Protein Provision in

Critical Illness: A Systematic and Narrative Review." American Journal of Clinical Nutrition 96.3 (2012): 591-600. Web.

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.

Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals: SECOND EDITION: Administrative and financial support provided by Paralyzed Veterans of America

Tappenden, K. A., B. Quatrara, M. L. Parkhurst, A. M. Malone, G. Fanjiang, and T. R. Ziegler. "Critical Role of Nutrition in Improving Quality of Care: An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition." Journal of Parenteral and Enteral Nutrition 37.4 (2013): 482-97. Web.

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BELIEVE

if there’s a willthere’s a way back

MAGEE Rehabilitation Hospital

THANK YOU!

Marci Ruediger, PT, M.S.mruediger@mageerehab.org215.587.3454

Julie Rece, MSN, RN, CRRN, CWOCNjrece@mageerehab.org215.587.3432

Amy Bratta,. PT, DPTabratta@mageerehab.org215.587.3218

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