P ressure U lcer P revention P lus I nventive E lectronic S olutions

• Clinical Dietician-Debbie Herbst

• Infection Control nurse-Teri Koch

• Point of Care/Patient Documentation-Nila Holmes

• Performance Improvement Coordinator-Jerry Roland

• Home Health Nurse- Patsy Wilson

• Materials Management-Varies

• Nursing Supervisors-Pattie Green

• Clinical med-surg-ICU nurses-Varies

• Physical Therapist-Bill Schmitt

• Nurse Assistant-Varies

• Home Health nurses-Amy Winemiller

• Certified Wound care nurse-Cheryl Cardwell

• Med-surg-ICU wound care nurse-Kim Morris

• Med-surg-ICU unit manager-Janice Duncan

We found that paper just isn’t enough. We need our electronic systems to help catch those patients that don’t fit the “at risk” pressure ulcer criteria outlined when utilizing the standard braden scale.

We may admit a patient with a pressure ulcer present upon admission to

the hospital.

The Braden Scale score can indicate that the patient is at minimal risk of skin breakdown, even though their

skin has already broken down!

That just doesn’t seem to make sense.

We tweaked our parameters. We still use the conventional braden scale but we

added additional features to assist us. Now those at risk patients don’t fall between the

cracks.

1. We added 2 checkboxes prior to performing the braden scale to indicate if a pressure ulcer is present on admission or not.

2. Once the checkbox indicating that a pressure ulcer is present on admission is selected, an electronic message is automatically generated sending a message to the Physicial therapists, the Wound care nurse, and the Dietician notifying them to screen the patient regardless of the braden score.

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1. We have included the Dietician’s screening process to help us identify patients at a nutritional risk of forming a pressure ulcer yet scored a low risk of forming a pressure ulcer on the braden scale.

2. We added a checkbox to the Dieitician’s electronic documentation that generates an automatic message to P.T. and to the wound care nurse. This notifies PT and the wound care nurse to screen or re-screen the patient regardless of the braden score. This helps us prevent the development of pressure ulcers on patients that are deemed nutritionally poor after admission or post-operatively. The nutritional status is rescreened on day 1, day 3, day 5 so this also helps us keep current with the patient’s status.

If this nutritional screen indicates that the patient may possibly be at a nutritional risk, the Dietician

then completes an initial assessment. If the last check

box/boxes are checked, an electronic automatic message will be sent notifying the Dietician to see this

patient.

Daily concurrent monitoring of dietary supplements occurs when entered electronically on the flowcharts and will automatically be calculated into the Intake and Output totals and graphic I&O.

Supplements and nutritional / hydration plans are entered onto an electronic record by the Dietician. This information will automatically copy forward to a discharge communication tool regarding pressure ulcers to enhance communication with post discharge facilities

• The pressure ulcer stage is automatically displayed on the patient summary tool used during shift report as part of our TeamSTEPPS™ effort to optimize our team performance across the healthcare delivery system.

• Any history of MRSA automatically populates the demographics, the virtual chart and the patient summary. A message is then generated to notify infection control of the MRSA admission.• An electronic set of “nursing orders” display with associated wound interventions for nurses and the CNAs to refer to. All intervetions are updated per physician order.

• An electronic careplan is initiated

Our cardiopulmonary department performs a pressure ulcer assessment, documentation and even interventions involving their oxygen delivery equipment. They document this on an electronic form. An electronic notification is then automatically generated to the nursing supervisors and to the wound care nurse for follow up.

It’s difficult to stage an ulcer correctly on admission.

We are developing a plan that will assist in auto-scoring the correct pressure ulcer stage and then prevent the nurse from later entering an incorrect stage level. We created a flowchart that calculates the stage based upon the description of the ulcer, and our trials were successful! We need to test further then implement in the near future. Example: Remember once an ulcer is staged, it can not be documented as a lower stage even after it’s healed. If it’s a stage 3 on admit, it’s a stage 3 or a healing stage 3. The ulcer may become worse but not a lower stage…

We are trying to develop an electronic method that will not allow backstaging of ulcers once staged.

We will begin using the electronic acuity which the nursing supervisors will review alerting them regarding a change in a patient’s status.

Ideally, the braden scale should be reassessed as the patient status changes. We will utilize our acuity tool to help us identify alterations in the level of care.

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The PUPPIES team works closely to ensure all process measures are working effectively

Thank You!