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The Wisconsin Pressure Ulcer Coalition (WPUC) 2011

The Wisconsin Pressure Ulcer Coalition (WPUC) 2011. Jody Rothe, RN, WCC Quality Consultant January 27, 2011. Objectives. Describe the WPUC structure and how to use the activities to improve your pressure ulcer prevention Determine next steps to improve your pressure ulcer prevention program.

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The Wisconsin Pressure Ulcer Coalition (WPUC) 2011

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  1. The Wisconsin Pressure Ulcer Coalition (WPUC) 2011 Jody Rothe, RN, WCC Quality Consultant January 27, 2011

  2. Objectives • Describe the WPUC structure and how to use the activities to improve your pressure ulcer prevention • Determine next steps to improve your pressure ulcer prevention program

  3. Thank You • Thank you for being a 2011 WPUC member • Goals of the WPUC • Reduce and prevent pressure ulcers • Foster cross setting communication

  4. 2011 Structure • Data submission • Monthly e-newsletter • Webinars • Community meetings • Educational DVD • Pressure ulcer bundle

  5. www.metastar.com

  6. Points of Quality

  7. Select Setting Nursing Home Page Hospital Page

  8. Pressure Ulcer Web Page

  9. Data • Data collection • Data submission • Data tracking & analysis • E-news data • Data tool posted under resources-data: • http://www.metastar.com/web/Default.aspx?tabid=339

  10. Data Measures • Timely Risk Assessment: Number of admissions that have a risk assessment performed within eight hours of admission • Numerator: ______________________________ • Denominator: ______________________________

  11. Data Measures (Cont.) • Timely Skin Assessment: Number of admissions that have a documented comprehensive skin assessment performed with eight hours of admission • Numerator: ______________________________ • Denominator: ______________________________

  12. Data Measures (Cont.) • Timely Preventive Strategies: Number of patients/residents/clients who receive preventive strategies within 24 hours of being identified as at risk • Numerator: ______________________________ • Denominator: ______________________________

  13. Data Measures (Cont.) • Pressure Ulcer Prevalence: Number of patients/residents/clients with pressure ulcers at one point in time during the month • Numerator: ______________________________ • Denominator: ______________________________

  14. Data Measures (Cont.) • Facility Acquired Rate: Number of residents with facility acquired pressure ulcers • Numerator: ______________________________ • Denominator : ______________________________

  15. Data Measures (Cont.) • Stage of Facility Acquired Pressure Ulcers • Stage I _____ • Stage II _____ • Stage III _____ • Stage IV _____ • Unstageable _____ • Deep Tissue Injury _____

  16. Data Resources

  17. Data Tool Sample

  18. E-Newsletter • Sent monthly via e-mail by Missie Bradley • Aggregate data • Upcoming events • Resources/tips of the month

  19. E-Newsletter (Cont.) • Submit a question to jrothe@metastar.com to have the question and answer posted in an e-newsletter • Link to resources on website: • http://www.metastar.com/web/Default.aspx?tabid=339

  20. Webinars • Invite will alert members of the webinar • Reminders in e-news • Three more webinars in the first half of 2011 • Survey Monkey • Past webinars at this link • http://www.metastar.com/web/Default.aspx?tabid=342

  21. Community Meetings • Why do I need to host a meeting? • What do I do with the information? • How can the meeting reduce and prevent pressure ulcers?

  22. Community Meeting Toolkit • Community Meeting Toolkit • http://www.metastar.com/web/Default.aspx?tabid=339 • Next Steps

  23. Educational DVD • Mailed to contact listed on enrollment form • Cross setting DVD for education of all staff

  24. Pressure Ulcer Bundle • How does my team use “The Bundle”? • CD sent to the contact on the enrollment form • Website Link: • http://www.metastar.com/web/Default.aspx?tabid=339

  25. Breaking Down “The Bundle” • Section 1: Organizational Commitment to Pressure Ulcer Prevention & Management • Section 2: Pressure Ulcer Prevention & Management Policies • Section 3: Educating Staff • Section 4: Screening, Assessing & Monitoring Pressure Ulcers

  26. Breaking Down “The Bundle” (Cont.) • Section 5: Prevention & Treatment of Pressure Ulcers • Section 6: Care Planning for Pressure Ulcers • Section 7: Quality Improvement Tools • Section 8: References

  27. Section 1: Organizational Commitment to Pressure Ulcer Prevention & Management • Commit your organization • Institute prevention program based on guidelines (AHCPR, AMDA) • Pressure ulcer risk assessments • Pressure relief • Develop plan of care

  28. Tools for Pressure Ulcer Prevention & Management • Pressure Ulcers: • Overview • Pressure Ulcers: • Essential systems for quality care • Flow Diagram: • Organizational commitment • Checklist: • Evaluate key steps for organizational system • Plan of Action – Pressure Ulcers: • Organizational commitment

  29. Section 2: Pressure Ulcer Prevention & Management Policies • Pressure Ulcer Prevention and Management • Assess, revise, develop policy & procedures • Develop protocols for screening for pressure ulcer risk • Monitoring prevention and treatment • Developing care plan

  30. Tools For Pressure Ulcer Prevention & Management • Checklist provided for assessing pressure ulcer policies • Outline of component of a pressure ulcer prevention & management policy • Pressure ulcers: • Annotated guidelines

  31. Section 3: Educating Staff • Key areas to include in training • Screening for resident risk factors • Prevention and early treatment options

  32. Key Areas to Include in Staff Education • Pressure ulcer assessment • Monitoring treatment & prevention for residents with pressure ulcers • Treatment options for pressure ulcers • Accurate documentation • Care planning/MDS coordination

  33. Tools for Staff Education • Checklist: • Assessing staff education and training • National Pressure Ulcer Advisory Panel Pressure Ulcer Treatment: • A competency-based curriculum • Content outline

  34. Section 4: Screening, Assessing, & Monitoring Pressure Ulcers • Screening tool should be done upon: admission, readmission, a change in condition, each MDS assessment • When performing a pressure ulcer risk screen, the tool should address the following: • Impaired mobility • Incontinence/moisture • Nutritional deficits • Altered level of consciousness • Altered sensory perception

  35. Assessment & Monitoring • Wound assessment should occur upon admission and at specified intervals thereafter. The pressure ulcer assessments should be at least weekly and include: • Site/location • Size • Pain • Stage • Drainage • Appearance • Physical health • Psychosocial status • Nutrition/ hydration status-nutritional assessment • Pain status-comprehensive pain assessment

  36. Tools for Screening, Assessing & Monitoring Pressure Ulcers • Checklist: screening for pressure ulcer risk • Flow diagram-pressure ulcers: • Risk Assessment • Pressure ulcer risk scales • Checklist: • Assessment & reassessment & monitoring treatment & prevention of pressure ulcers • Assessment and tracking tools examples

  37. Section 5: Prevention & Treatment of Pressure Ulcers • Early prevention intervention may include: • Protecting skin against effects of pressure, friction, & shear • Protecting skin from moisture • Encouraging optimal nutrition and fluid intake

  38. Treatment • Clinical Practice Guidelines provide current principles and protocols for prevention and treatment • 1996 AMDA Pressure Ulcer Clinical Practice Guideline: Pressure Ulcers • 1999 AMDA Clinical Practice Guideline: Pressure Ulcer Therapy Companion • AHCPR Clinical Practice Guideline #3: Pressure Ulcers in Adults: Predication and Prevention • AHCRP Clinical Practice Guideline #15: Pressure Ulcer Treatment

  39. Tools for Prevention & Treatment • Pressure Ulcer Prediction & Prevention Algorithm • Clinical Algorithm: • Management of Pressure Ulcers – Overview • Clinical Algorithm: • Ulcer Care • Clinical Algorithm: • Management of Tissue Loads • Pressure Ulcers: • Communication with Physician • Provides a sample form that nursing staff can complete before contacting a physician

  40. Section 6: Care Planning for Pressure Ulcers • Development of a care plan • Interdisciplinary team needs to be involved • Areas of risks and interventions should be addressed in the resident’s care plan as they apply to specific problems • Education of the resident and family

  41. Care Plan • Once care plan developed, the process involves: • Implementation of the plan of care • Monitoring the response to the plan of care • Ensuring oversight (person(s) or team) for implementation • Reassessment of the plan of care

  42. Tools for Care Planning • Checklist: • Developing a pressure ulcer care plan • Education tool for residents & families: • Pressure ulcers

  43. Section 7: Quality Improvement • A systems approach to Quality Improvement • Through analysis of current process that make up the systems, the Pressure Ulcer Quality Improvement Workgroup can determine which problems are areas that need improvement

  44. Tools For Quality Improvement • Worksheets • Plan of Action – Pressure Ulcers: • Organizational commitment

  45. Root Cause Analysis

  46. Section 8: References • Pressure Ulcer Reduction and Prevention Project “The Bundle”

  47. The Six Elements of IHI Bundle • Conduct a pressure ulcer admission assessment for all patients • Reassess risk for all patients daily • Inspect skin daily • Manage moisture: keep patient dry & moisturize skin • Optimize nutrition and hydration • Minimize pressure

  48. Pressure Ulcer Admission Risk & Skin Assessment • Conduct • For all patients • For risk • For detection • Gather data • Braden Scale, Norton Scale

  49. Daily Risk Reassessment • Triggers • Mobility • Incontinence • Nutrition • Procedures • Preventive Steps • Policy & procedure

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