UPMC St. Margaret’s Hospital

Preventing Falls and Pressure

Ulcers: A Strategic Plan

Presented By

DNP Consultant Team

Sunday, July 29, 2012

Waynesburg Monroeville Cohort

Margaret A. Boyce, MSN, MBA, RN

Karen G. Chambers, MSN, CGRN, RN

Janet Kovatch-Janovsky, MSN, RN

Melissa L. Mastorovich, MSN, BC, RN

Melissa L. Rudd, MSN, CRNP

UPMC St. Margaret’s

Demographics

Established late 1800’s

Magnet status

249 Bed acute care and teaching

community hospital

Serves 250,000 residents of

Allegheny County

St. Margaret’s Mission Statement

To provide premier programs

in patient care, biomedical and

health services research, and

teaching that contributes to

the prevention, diagnosis, and

treatment of human disease

and disability.

Kotter’s Model

SMH Leadership

Team Proposal

Create an inter professional approach to

recognition, evaluation and prevention of

patient falls & facility acquired

pressure ulcers in an acute care hospital

Strengths Current administrative teams

QI teams

Engaged staff

Two ET nurses

Staff mix

Weaknesses Limited resource staff

Inconsistent safety measures

Turning regimen

Ulcer staging

Bedside report

Obstacles Lack of “buy in”

Budget constraints

Sustainability

Threats Decreased reimbursement

Decreased patient satisfaction

Personnel recruitment and retention

SWOT

National Fall Statistics

Most common cause of injuries and

hospital admissions among the

elderly (Moyer,2011)

The second leading cause of injury –

related deaths for people ages 65 and

older (Moyer,2011)

By 2020 fall costs will exceed $30

billion (Chang et al., 2004; Ulrich& Zimring,2004)

SMH Fall Statistics

60% Falls occur

in pts A & O X 3

and > 60 years

RCA = No

Correlation

Goal 288/year

230

240

250

260

270

280

290

300

FALL PREVALENCE

FY 2010

FY 2011

FY 2012

255

pts

292

pts

252

pts

SMH FALL PREVALENCE

Survey Monkey

Survey Monkey Results

22.1%

15.9%

18.2%

42.9%

RN Years of Service

< 2 years

3-5 years

6-14 years

> 15 year

62% 15%

24%

.

FREQUENCY FOR FALL ASSESSMENT

QSHIFT Q 4 HRS Q 1 HR

HOW OFTEN DO YOU

ASSESS FOR FALLS?

Very familiar

67%

Somewhat

familiar 32%

Not at all

1% .

HOW FAMILIAR ARE YOU WITH

THE CURRENT FALL POLICY?

NO 52.1%

Yes

47.9%

DO YOU BELIEVE YOU ARE STAFFED

APPROPRIATELY TO PREVENT FALLS?

5.5%

57.5%

37.0%

Fall Prevention and Patient/Family Teaching

On admissiononly

q shift

As the situationarises

HOW OFTEN DO YOU PROVIDE PATIENT FAMILY TEACHING REGARDING FALL PREVENTION?

SMH Leadership

Team Proposal

Create an inter professional approach to

recognition, evaluation and prevention of

facility acquired skin ulcers in an

acute care hospital.

National Skin Ulcer Statistics

2.5 million patients treated yearly for

hospital acquired pressure ulcers

(HAPU);

Expenditures total $11 billion yearly;

HAPU is 5% in acute care;

Results in increased length of

stay by 9 days (Ayello,2011)

SMH Skin Statistics

162 HAPU (1%)

77 (48%) Patients Were Stage 2

Ulcers

Majority Were ICU Patients

RCA = No Correlation among

variables

Survey Monkey

8.1% on adm.

75.7% q shift

13.5%

q 4 hr

2.7%

q 1 hr

HOW FREQUENTLY DO YOU ASSESS HEAD TO

TOE SKIN INTEGRITY?

54.1% 40.5%

5.4%

HOW FAMILIAR ARE YOU WITH THE

SKIN CARE POLICY?

Very familiar

Somewhatfamiliar

Not at all

NO 60.6%

Yes 39.4%

DO YOU BELIEVE THAT YOU ARE STAFFED

APPROPRIATELY TO PREVENT SKIN BREAKDOWN?

4.0%

Q shift

44.0%

2.7%

HOW OFTEN DO YOU EDUCATE YOUR PATIENTS

AND FAMILIES ABOUT PRESSURE ULCERS?

On admission only

Q shift

As the situation arises(prn)

Only the high riskpatients

49.3%

AS THE

SITUATION

ARISES

43.8% 56.2

%

Yes

No

WOULD A REMINDER ON THE CERNER HELP YOU DO

A MORE COMPREHENSIVE ASSESSMENT?

Evidence Based

Practice Findings

Communication

Bedside Report

Hourly Rounding

Enhance Patient-Centered Care

Education

Fall & Skin Unit Champions

Whiteboard

Whiteboard

Recommendations

Bedside Report (Halm, 2009; Bonuel, 2011)

HOURLY COMFORT ROUNDING

5- P’s (Potty, Pain, Position, Pumps,

Personal)(Halm, 2009; Bonuel, 2011; Studer et al., 2010)

Ringtones

Variable Rounder

Interdisciplinary Team

Recommendations

Enhanced Patient-Centered Care (McCane, McCormack, Dewing, 2011)

Quality & Patient Safety Brochure (www.njha.com)

SYMBOLISM

Recommendations

Implement Fall and Skin

Unit Champions

Fall Fridays

Wound Wednesdays

Fuddles

Education

Recommendations

Journal club

Fall February

Skin September

Orientation

Annual Competencies

& Skills Fair

Newsletter-E

Questions ?