Goldstamp PUP cleaned version - University at Albany, SUNY1/13/2016 2 Webinar Guidelines This...
Transcript of Goldstamp PUP cleaned version - University at Albany, SUNY1/13/2016 2 Webinar Guidelines This...
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Innovations to Stop Pressure Ulcers among Patients at
Critically High Risk for Pressure Ulcer Development
– a Multidisciplinary Approach
JANUARY 14, 2016
www.goldstamp.org
Webinar Producer
Sue BrooksOnline Production AssistantWeb Page ManagerExpert Synchronous Webinar Producer
Webinar Guidelines 1 hour presentation including a
discussion period at the end.
Send your questions at any time during the presentation via the chat box on your screen.
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Webinar Guidelines
This webinar will be recorded and available ‘on demand’ for future viewing. www.goldstamp.org
Turn on your computer speakers for sound
Handouts are available to download: Right side of your screen www.goldstamp.org
Continuing Education Credits
CNE’s, CME’s and CHES : Please complete the post test and evaluation on
www.goldstamp.org The School of Public Health, University at Albany is an approved provider of continuing nurse
education by the. American Nurses Association Massachusetts (ANA MASS), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
This offering is approved for 1 nursing contact hour.
The School of Public Health, University at Albany is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians.
The School of Public Health, University at Albany designates this live activity for a maximum of 1 AMA PRA Category 1 CreditsTM . Physicians should claim credit commensurate with the extent of their participation in the activity.
Sponsored by the School of Public Health, University at Albany, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to .5 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 0.
This project is funded through a Memorandum of Understanding with the NYS Department of Health.
There is no commercial interest funding this program.
The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.
Objectives
Identify three best practices to prevent pressure ulcers in patients at highest risk.
Describe one strategy for involving various interdisciplinary team members in a pressure ulcer prevention collaboration.
Recognize innovative pressure ulcer prevention actions which can be replicated in different settings.
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Speakers 7Marci Ruediger, PT, [email protected]
Julie Rece, MSN, RN, CRRN, [email protected]
Amy Bratta,. PT, [email protected]
96 Bed Inpatient Acute Rehab Hospital
8About Magee
9About Magee
Outpatient Satellite Clinics
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How we got started 10
Baseline efforts Strong collaboration -
wound care and nutrition
High quality tube-feeding supplements
Advanced seating capabilities
Everyone turned and shifted
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Nursing-Specific Actions
Head to toe assessment by RN, WOCN, MD
Head of bed Weekly full body
assessment with photos
Shift of WOCN hours
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WOC Team
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Barriers for Skin Protection
Foam
Ointments
pH balanced skin cleanser
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Supplies
Liberal use of barriers - protect intact skin exposed to stool
Elimination of plastic from bed pads and briefs
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Nursing-Specific Communication
Staff education Wound care
formulary Supply
guidelines
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Equipment 16
Nutrition 17 Assess for malnutrition on
admission and initiate support
Meet at least 80% of protein needs
Use tube feeding formulas with liquid modular proteins as needed
WOCNs and RDs communicate throughout the day
Poop in a Group 18
PhysicianWOCN
Front-line nurse –BI/stroke
Therapy Seating Specialist
Pharmacy Director
Nurse manager -SCI
Nutrition
Nursing supervisor General Rehab
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Physician-Specific Actions
Physician champion
Assess skin at admission
Engage nursing assistants
Work with WOCN to identify and stage ulcers
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Therapy Innovations 20
Therapy Innovations 21
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Interdisciplinary Innovations 22
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Skin Peers 24
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Leadership 25
Collaboration with other providers
Bracelets for transported patients Brain-storming with providers from
a cardio-thoracic ICU PA Hospital Engagement Network
3 - year collaborative
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Culture Change
Moisture dermatitis as “stage 0”
Sense of urgency related to prevention of skin breakdown
Principles of Just Culture applied
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Results to Date
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
FY 12 FY 13 FY 14 FY 15
Serious Pressure Ulcers per 1000 Patient Days
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Why did it take so long? 29
The Challenge of Wicked Problems
New challenges with devices
Staff turn-over
New patient challenges
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Replication of Process
Interdisciplinary work
Iterative process
Innovation –creating solutions
Not accepting failure
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Lessons We Learn Again and Again
Leadership and accountability matter
Without these - > much work and no improvement
Things get “unfixed” without constant vigilance.
“Over-communication” is a necessity.
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Having Fun While Raising Awareness
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References Carson, D, Emmons K, Falone W, and Preston AM.
Development of Pressure Ulcer Program across a University Health System. J Nurs Care Qual. 2011; Vol. 00, No. 00, pp. 1-8.
Coleman S, Nixon J, Keen J, et al. A New Pressure Ulcer Conceptual Framework. Journal of Advanced Nursing. 2014; 70(10), 2222-2234.
Cox, J., and L. Rasmussen. "Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients." Critical Care Nurse 34.6 (2014): 15-27. Web.
DeJong G, Hsieh CJ, et al. Factors Associated with Pressure Ulcer Risk in Spinal Cord Injury Rehabilitation. Am J Phys Med Rehabil 2014; 00:1-16.
Edsberg LE, Langemo D, Baharestani MM, et al. Unavoidable Pressure Injury: State of the Science and Consensus Outcomes. J Wound Ostomy Continence Nurs. 2014; 41 (4): 313-334.
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References (continued) Hoffer, L. J., and B. R. Bistrian. "Appropriate Protein Provision in
Critical Illness: A Systematic and Narrative Review." American Journal of Clinical Nutrition 96.3 (2012): 591-600. Web.
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals: SECOND EDITION: Administrative and financial support provided by Paralyzed Veterans of America
Tappenden, K. A., B. Quatrara, M. L. Parkhurst, A. M. Malone, G. Fanjiang, and T. R. Ziegler. "Critical Role of Nutrition in Improving Quality of Care: An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition." Journal of Parenteral and Enteral Nutrition 37.4 (2013): 482-97. Web.
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BELIEVE
if there’s a willthere’s a way back
MAGEE Rehabilitation Hospital
THANK YOU!
Marci Ruediger, PT, [email protected]
Julie Rece, MSN, RN, CRRN, [email protected]
Amy Bratta,. PT, [email protected]
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www.goldstamp.org Evaluation and Post-test
http://www.ualbanycphp.org/eval/sphEval.cfm?ID=269
Click here to fill out the evaluation and post-test for free continuing education credits.