Fall update: The project begins

Login
|
Home
|
JCI
|
Blogs
|
FAQs
|
Contact JCR

9/9/2009
Author: Nurse Scholar
Category: Nurse Safety Scholar Blog on Pressure Ulcers
23743 Views
5 Comments

Fall update: The project begins – Act I: Setting the Stage - Meeting the Players

Act II: On-site Visits - Identifying the Problems

Act III: Actions and Resolutions

First, I want to start this update with a few responses to comments on the blog. There is one question asking whether the new NPUAP guidelines are included in the new Joint Commission publication, Clinical Care Improvement Strategies: Pressure Ulcer Prevention. Since the updated NPUAP guidelines have not yet been released, they are not included in this book.

Another question came up regarding keeping skin care products at the patient’s bedside and issues related to application of these products by non-licensed personnel. I called the expert at The Joint Commission and received an explanation that I hope will be helpful to our bedside practitioners. This is my interpretation of what was said and does not indicate any ruling on the part of The Joint Commission. Classification of skin care products as over-the-counter medications is determined by the FDA. Medication administration rules may require a licensed professional to apply these products, but this decision is made by the individual states. If your state allows, these products can be left at the patient’s bedside and can be applied by nursing assistants; however, this must be delineated in your policies and procedures once your facility has done a risk assessment. It is good practice to have the patient’s name on the products being used and to make sure that nursing assistants have been trained in the appropriate usage of skin care products.

Another blogger brought up issues related to some confusing terminology in some of the pressure ulcer prevention guidelines documents. Grace says, “what is meant by the term special bed”? Another term in guidelines mentions using “high density foam.” One group that is working to clarify these terms is the PUCI group: www.aawconline.org/PUCI%20outlineTableFormV20-web21Aug09.pdf

Dr. Laura Bolton and her team are working to review all of the published guidelines and offer clarification of confusing terminology. Thank you, Dr. Bolton, and your team of dedicated volunteers!

My favorite blog comments come from WOC practitioners who have been able to design and implement comprehensive pressure ulcer prevention programs. Read
what Cathy Van Houten says about what she has accomplished in her hospital! Amazing work!

Finally, here is an update on my Three Act Play project with Joint Commission Resources with support and input from Hill-Rom experts.

Act 1: The players have been selected and we’ve had some initial conference calls as a way of setting the stage for Act 2. Four hospital systems will be participating and they are located in New York City, Philadelphia, Birmingham, and Richmond. We’ve had initial conference calls with the participating facilities. Each facility has a multidisciplinary committee/council in place and they are working toward identifying specific barriers to prevention. More facility-specific details to follow.

Act 2: We have asked for some specifics that support the committee’s ideas of barriers and we will begin a round of site visits over the next few weeks. Each facility is planning a “town hall” meeting with the committee, myself and Deborah Nadzam, my mentor at JCR. At this town hall meeting we will be receiving “testimony” from the various hospital departments that interact with patients telling us what they know about pressure ulcer prevention and how they are participating or plan to participate in the prevention of pressure and incontinence related injuries. The process of correctly identifying barriers is important to the success of the project. Once the committee is secure in the belief that correct barriers have been identified, we can move to Act 3—action plans and resolution of the problems.

An annotated bibliography of articles discussing implementation projects will be provided for those who may be interested in learning more about this subject.

Best regards to all –

Turn, Turn, Turn

Irene

User Comments

On 10/9/2009 Irene Jankowski said:

Sorry slow to come back with information about the mobility team I learned about. Deborah Nadzam of JCR and I have been travelling all week meeting with the pressure ulcer prevention teams for the participating hospital in Alabama and the team at my own hospital in New York. The hospital nurses involved in this project are all doing so many of the same things but have identified obstacles and solutions that may be very different depending upon how far along facilities' programs are with hospital-wide implementation. Regarding mobility teams, as mentioned before there is a company we learned about in Virginia that offers a service to hospitals related to repositioning and moving patients. A business case for this program was made that demonstrated cost savings from decreased staff injuries. I am not sure about whether the HAPU rate has decreased since implementation of this team (good question), but will work to get this info onto the blog. Irene

On 10/5/2009 Irene Jankowski said:

Regarding facilities that have achieved zero pressure ulcer rates, see Gibbons article in the annotated bibliography about the experience at Ascension Health hospitals. Programs like the one that they describe are having excellent outcomes. In terms of mobility teams, will get more information about the team I learned about and add to the blog tomorrow. Thanks for taking the time to participate in this blog. Best regards, Irene

On 10/4/2009 faye Militante said:

After 15 years of home health, I've been back into acute care for nearly 4 years. I'd be curious in learning more about out-sourcing the "mobility teams" and the pressure ulcer rates that are zero on most units. Is there a before the teams got put into place? And they are able to help position to assist with dressing changes? that truly would be an awesome accomplishment if we could reach either the zero ulcer rate or help for positioning for dressing changes...

On 10/1/2009 Margaret said:

What is happening with ensuring nursing assistant and nurse education programs are including effective pressure ulcer prevention strategies within their programs. Will this work you are doing impact licensing at all.

On 10/1/2009 Irene Jankowski said:

Hello to all. We are in the middle of our site visits and already seeing common threads. First of all, I must stress the importance of making sure that nurses receive structured education and re-education in timely intervals regarding using Braden. Since facilities are using this tool to generate interventions, wrong information may translate to wrong or delayed interventions. It's interesting to look at how different facilities are using braden to drive care while others just do the braden score and the score is just another part of documentation. Second thing - wow we nurses are really good at fixing problems aren't we? Unfortunately we put in quick fixes but don't look for root causes. This means more work for nurses since the actual problem can't be corrected until we work with all involved to find the difinitive solution. We are seeing this with supply chain issues - nurses are good at creating "stashes" of equipment since what we need may not be there. Would like to hear from facilities who have a smooth system for getting appropriate supplies onto the nursing unit so that we can stop spending time hunting for supplies. Learning some great things too - so enough complaining. One facility is using mobility teams that round on units, turn patients every 2 hours, assist with positioning patients to assist nurses with dressing changes, etc. The hospital has outsourced this to another company and the process is working amazingly well. This facility is looking a zero pressure ulcer rates on most units and a decrease in staff injuries related to moving patients. Would like to hear your comments. More updates to follow. Best regards to all and keep turning. Irene

Name:
Email:
URL:
Comment:
Security Code:
Type Security Code:

Quick Links

Joint Commission Requirements

E-dition

National Patient Safety Goals

View All Products

Join Our Email List

2011 Fall Catalog

Fall update: The project begins

User Comments

Leave a Comment