Introduction Hospital Acquired Pressure Injuries (HAPIs) are a frequently occurring health - PowerPoint Presentation

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Introduction

Hospital Acquired Pressure Injuries (HAPIs) are a frequently occurring health care problem, affecting millions of patients annually, and contribute to decreased patient quality of life and safety, increased length of stay, increased medical costs, increased risk of morbidity and mortality, and financial liability if considered hospital acquired.There was not a standard or established process for preventing, identifying, or reporting HAPIs at Abington Jefferson Health (AJH), which has led to possible under reporting of pressure injuries present on admission and/or a skin injury that worsens under our care.AIM Statement: Identify at least 20 nurses to complete the Skin Saver Champion training program to implement a standard process for a proactive approach of optimizing skin care and to achieve a pressure injury incidence rate of <0.35 pressure injuries per 1000 patient admissions by June 2020.Improvement Plan: Create a culture of world class skin care and improve the competence and awareness of HAPIs by building a community of learning for the unit-based Skin Saver Champion program to help provide excellent proactive evidence-based care for our patients.

Methods

Understand the causes for inconsistencies of identifying, documenting & reporting HAPIs using a fishbone diagram (see below).Determine the current state and map the future state process for identification, documentation, escalation, and reporting of HAPIs.Define the role of a Skin Saver Champion.Develop the training and competency curriculum for the Skin Saver Champions to provide more efficient care delivery and proactively promote pressure injury prevention and early interventions.Lead monthly pressure injury surveys, conduct unit focus review audits, monitor outcomes, implement intervention strategies/quality improvement. Implement a 2 RN skin assessment to embed tools to support a culture of safety and increase situational awareness and accountability.

Results

Discussion

The goal of this project is to promote the delivery of excellent skin and wound care through the establishment of a unit-based multi-disciplinary team, development of standardized protocols and processes for identifying, documenting, and reporting HAPIs. The Skin Saver Champion program incorporates best practice guidelines from the Wound Ostomy and Continence Society to implement and maintain a pressure injury prevention program. This model of capacity building at the unit level is an innovative program that is aimed at solving a crucial need – improving patient outcomes (decreasing HAPIs) at the frontline of care with early detection and interventions.

Conclusion and Future Steps

The development of the Unit-Based Skin Saver program has gained the support of administration and leadership at AJH. After creating the 4-hour onboarding education and training program, the WOCN team has successfully trained a total of 29 RN’s to be the local resource to promote best practices for skin care to improve quality care. The remaining 22 RN’s will complete the Skin Saver training by Dec. 2019.Now that AJH has 51 Skin Saver Champion volunteers, the next steps are to:Communicate and advertise Skin Saver presence, expectations, and roles to the rest of the staff on the units. “Who’s YOUR Skin Saver?” Campaign. Complete unit QI standard 2-RN skin assessment audits and documentation of pressure injuries present on admission (POA) to report up to the local leadership and the Wound Council.Create and/or modify a unit-based daily briefing form to include skin issues.Continue monthly education meetings (to sustain competency), share ideas, share lessons learned, and improve interprofessional communication. Ongoing monitoring of monthly wound prevalence audits and reporting of HAPIs.

References

Quality Improvement/Patient Safety Leadership Program 2019 Development of Unit-Based Skin Saver Champion ProgramSarah Schein MS, RD, LDN, Katherine Rohrback BSN, RN, CWOCN

Elements of the Unit-Based Skin Saver Champion Program

Unit Dashboard with the Addition of Pressure Ulcer Data

Sustaining all pieces of the Skin Saver Champion Program

Understanding the Inconsistencies of Identifying & Reporting HAPIs

Key Findings from the Fishbone Diagram

The primary causes identified from the

Fishbone

diagram were the inability to recognize new/worsening pressure injury (lack of knowledge), lack of local resources for staff & patients on each unit, and the variations in skin assessment & timing.

There were several initial steps that needed to be completed in order to implement the improvement plan of creating a

new Unit-Based Skin Saver Champion

Program. Creating a future state HAPI process map, defining the role of the Skin Savers, recruiting and training the Skin Savers, and implementing a way to easily monitor and display pressure injury data on the unit dashboards.

Niederhauser A., Van Deusen, L.C., Parker, V., Ayello, K., Berlowitz, D., Comprehensive

Programs

for Preventing Pressure Ulcers: A Review of the Literature. Advances in Skin

and

Wound Care. 2012; 25(4):167-188.

Pressure Injury Prevention in Hospitals Training Program. Content last reviewed October

2017

.

Agency

for Healthcare and Research and Quality. Retrieved October 3, 2019 from:

https

://

www.ahrq.gov/patient-safety/settings/hospital/resource/pressure-injury/index.html

Wound, Ostomy and Continence Nurses Society-Wound Guidelines Task Force. WOCN 2016

Guideline

for Prevention and Management of Pressure Injuries (Ulcers).  Journal of

Wound

, Ostomy and Continence Nursing. May/June 2017; 44(3): 241-246.