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Best Practices in Home Care: Pressure Ulcer Prevention. Background of the Pressure Ulcer Prevention Initiative. The importance of quality in wound management has never been greater with the implementation of OASIS C. - PowerPoint PPT Presentation
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Best Practices in Home Care:Pressure Ulcer Prevention
Background of the Pressure Ulcer Prevention Initiative• The importance of quality in wound management has
never been greater with the implementation of OASIS C. • Since the Fall of 2011, a total of four wound-associated
items, three of which are related to Pressure Ulcers, have been publicly reported on the Home Health Compare Website.
• Utilizing the Home Health Compare website, CMS is informing healthcare consumers of homecare agencies that conduct pressure ulcer risk assessment, communicate with physicians to obtain orders for pressure ulcer prevention and implement measures to reduce the development of pressure ulcers.
Pressure Ulcers Incidence in St. Luke’s Home Health Patients
Higher incidence of Increase in the Number of Pressure Ulcers
Chart audits revealed Pressure ulcers possibly missed at SOC Other wound etiologies mistakenly labeled as
pressure ulcers Inconsistent documentation of interventions for
patients determined to be at risk based on the Braden Scale
VNA of St. Luke's
Increase in Number of Pressure Ulcers January 2006 - June 2009
Source CASPER
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
VNA 1.32% 1.39% 1.07% 1.82% 0.72% 1.02% 1.28% 1.45% 0.61% 2.05% 1.15% 1.31% 0.89% 0.71% 1.00% 1.22%
Reference 1.00% 0.94% 0.96% 0.94% 0.92% 0.87% 0.88% 0.86% 0.86% 0.84% 0.85% 0.81% 0.81% 0.76% 0.81% 0.77%
Qtr 3 2005
Qtr 4 2005
Qtr 1 2006
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Qtr 1 2008
Qtr 2 2008
Qtr 3 2008
Qtr 4 2008
Qtr 1 2009
Qtr 2 2009
Problem
The VNA of St. Luke’s Home Health patients experienced a higher incidence of developing pressure ulcers compared to the national reference
Aim The VNA of St. Luke’s Home Health incidence
of pressure ulcers will be lower than the national reference by April 2010
Our PI Team
Two Wound Care Certified RN’s
One Home Health RN One Physical Therapist Home Health Quality
Manager Home Health and Network
Hospital Leadership
Our Plan… Develop a comprehensive pressure ulcer prevention
program that targets multiple factors that contribute to pressure ulcer formation Develop script for clinicians to use with patients to explain
importance of head to toe skin assessment Devise a consistent process when instructing patients on measures
to prevent pressure ulcers including use of a skin care product Add prompts related to pressure ulcer prevention to OASIS to
remind clinicians to educate patients at risk and to facilitate ease of documentation
Create resource tools containing pictures of pressure ulcers at various stages and guidance for OASIS M questions related to pressure ulcers
Educate staff through a train the trainer process based on clinician’s perceived need
Do…
Process Patients with a Braden Score of 18 or less received a free
prevention product• Purple cap for patients with “pretty” skin• Blue cap for patients in need of a “barrier” due to moist skin
Added check off boxes to OASIS to prompt clinicians to provide education patients at risk and to facilitate ease of documentation
Product Provided patients with a tangible product and had staff “show and
tell” about the product’s use lending credence to the importance of skin care
Do. . .
Pictures Developed resource tools containing pictures of
pressure ulcers at various stages and CMS guidance on answer pressure ulcer M questions on OASIS
People Added teaching handout on pressure ulcer
prevention to each admission packet Evaluated staff’s perceived knowledge of
pressure ulcer staging, prevention and product use as well as their ability to document OASIS C responses using a survey tool
Phase 3: CHECKVNA of St. Luke's
Increase in Number of Pressure Ulcers January 2006 - September 2010
Sources: CASPER/OCS
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
VNA 1.32% 1.39% 1.07% 1.82% 0.72% 1.02% 1.28% 1.45% 0.61% 2.05% 1.15% 1.31% 0.89% 0.71% 1.00% 1.22% 0.13% 0.68% 0.40% 0.10% 0.10%
Reference 1.00% 0.94% 0.96% 0.94% 0.92% 0.87% 0.88% 0.86% 0.86% 0.84% 0.85% 0.81% 0.81% 0.76% 0.81% 0.77% 0.75% 0.72% 0.80% 0.40%
Qtr 3 2005
Qtr 4 2005
Qtr 1 2006
Qtr 2 2006
Qtr 3 2006
Qtr 4 2006
Qtr 1 2007
Qtr 2 2007
Qtr 3 2007
Qtr 4 2007
Qtr 1 2008
Qtr 2 2008
Qtr 3 2008
Qtr 4 2008
Qtr 1 2009
Qtr 2 2009
Qtr 3 2009
Qtr 4 2009
Qtr 1 2010
Qtr 2 2010
Qtr 3 2010
Phase 4: ACT
Develop and distribute body map containing location sites to promote consistent wound labeling
Develop and distribute wound product resource tool that describes product purpose and use for wounds of various etiologies including pressure ulcers
Questions…
VNA
Mission The Visiting Nurse Association of St. Luke’s, as part
of the St. Luke’s Hospital & Health Network, will provide compassionate, excellent quality, cost effective home health care, hospice services and home based parent/child programs.
VisionThe Visiting Nurse Association of St. Luke’s will be the Leader in Community Based Healthcare.