Pressure Ulcer Collaborative Implementing a Change Process Saint Elizabeth Manor March 10, 2009

Pressure Ulcer CollaborativeImplementing a Change Process

Saint Elizabeth ManorMarch 10, 2009

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Quality Partners of Rhode Island

General Overview of the ProjectParticipated in Wound Collaborative 2003/2004Initiated many changes that required the support of Administration in time and dollars

Goals:• Fewer pressure ulcers• Increased overall staff awareness

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Problem or Difficulty the Change Was Designed to Address:

1. The problem simply was to decrease the number of facility acquired pressure ulcers

2. Lack of staff awareness

3. Review currently used devices, assessments, tools and products for effectiveness

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What are the Significant Results?

1. Decreased the facility acquired pressure ulcers2. Increased staff awareness3. Achieved quicker identification of pressure areas and

initial treatment4. Quicker healing times

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Start


The Steps in Developing the Project

1.Education:for all staff from all departments,residents and family members

• Kick-off event: Theme was “PUP”

Pressure Ulcer Prevention

Inservices

All staff received a ribbon/bookmark

Incentives

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Practice Success ThroughPrevention… Skin Care Report CardReport these changes to a nurse:• Reddened skin• Bluish or purple skin mark• Black heel• Rashes• Denuded or raw skin• Skin tears• Other unusual conditions


Ten Commandments of Wound Care1. Thou shall not use donuts or eggcrates2. Thou shall not use cytotoxic agents in wounds(betadine)3. Thou shall not massage bony prominences.4. Thou shall turn residents every 2 hours and use a pull sheet5. Thou shall observe the 30o rule6. Thou shall keep heels off the bed7. Thou shall maintain continence and keep skin dry and

moisturized8. Thou shall keep residents level of functioning intact9. Thou shall use moist wound healing in the treatment of all

wounds10. Thou shall educate residents and families in wound care.Karen Treloar RN Catholic Memorial Hospital, Fall River, Ma


The Steps in Developing the Project2.PRODUCTS• Smith & Nephew: Barrier cream/EPC cream• Skin Report Cards


The Steps in Developing the Project3.DEVICES• Mattresses: Changed to high density foam• No egg crates• BRIEFS: off at night• No Chux• Cushions


The Steps in Developing the Project4.TOOLS• Assessment Tool: Braden• Pressure Ulcer Healing: PUSH Tool• Helping Hands


Hand Sign

Room #:______

Device:_______

Resident:______

Signature:_____

Date:__________


1.Resistance from staff and residents especially regarding briefs

2. Cost increases

3.Time

Limitations or Problems Encountered

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How were you able to overcome the problem?1.Briefs were gradually eliminated-include C.N.As in

the process from the beginning and try one area/corridor at a time.

2. Costs initially increased, but with decrease in pressure area numbers savings increased in both product and staff time.

3. Time commitment: Need time to do education sessions and also use of the time of others to assist: DON/Staff Dev/Unit Managers

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Partners in the Change process: EVERYONE MUST BUY IN AND HELP!

Including: Staff/Residents/Families

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The Resources, Products and Tools • We created an overall sense of awareness by

everyone.• Awareness became standard practice• “We really don’t think about it anymore, we just

automatically do it”

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Advice to Other Organizations

• Any tips that might help someone who follows in your path

1. Make the commitment-Be willing to initially increase some costs and invest staff time

2. Education leads to awareness.

3. Education is for everyone

4. Monitor your outcomes.

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Contact Information

• MaryJean Sylvaria• Saint Elizabeth Manor-Bristol• 253-2300• [email protected]

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Documents

Pressure Ulcer Collaborative Implementing a Change Process Saint Elizabeth Manor March 10, 2009