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		<title>Nurse Safety Scholar</title>
		<link>http://www.jcrinc.com</link>
		<description>Blog</description>
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					<title>Final Blog</title> 
					<link>http://www.jcrinc.com/Blog/2011/12/12/Final-Blog/</link> 
					<description><![CDATA[
		Dear colleagues, 
		As we transition to the end of final phase to the JCR/Hill-Rom Nurse Pressure Ulcer Prevention Project it is indeed bittersweet.  So much good work has come from the project and new connections have been forged.  But, as with all good things it must come to an end.  Therefore, it is with great pleasure and immense respect that I thank my fellow scholars Irene Jankowski and Diane Whitworth, project site leaders Mike Willis, Judy DiPerri, and Terri Murphy, Hill-Rom, Joint Commission Resources, The University of Pittsburgh Medical Center, and the numerous colleagues whose work and tireless efforts to prevent pressure ulcers do not go unnoticed. I applaud you!
		
				I extend an endearing thank you to the JCR and Hill-Rom for the opportunity to serve and to be mentored as the Nurse Safety Scholar-in-Residence. The invaluable mentorship will continue to build both my professional and personal growth especially in the work to prevent pressure ulcers. 
		
				I would like to take this opportunity to thank you as interested readers. You are invited to view the power point summary presentation (posted on this website) highlighting the delivered works of the project. You will find the delivered project tools such a complimentary webinar, Establishing a Pressure Ulcer Prevention Program Through Team Development, the article written by our first scholar Irene Jankowski, Identifying Gaps, Barriers, and Solutions in Implementing Pressure Ulcer Prevention Programs, and the Pressure Ulcer prevention Program Inventory Assessment. These are available under the tools/resources link for this website. The work of the project does not end here but will continue to be available as a valuable resource. As you look ahead to the New Year and continuing your work to developing pressure ulcer prevention programs, keep in mind the project resources will continue to be posted with any questions to be forwarded to JCR project director Nanne Finis at nfinis@jcrinc.com. It has been an invaluable experience and pleasure. 
		
				Thank you! Cece
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					<pubDate>Mon, 12 Dec 2011 16:03:05 GMT</pubDate>
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					<title>Family as Caregivers: Teaching Pressure Ulcer Prevention</title> 
					<link>http://www.jcrinc.com/Blog/2011/11/2/Family-as-Caregivers-Teaching-Pressure-Ulcer-Prevention/</link> 
					<description><![CDATA[
		Teaching strategies to prevent pressure ulcers have historically been focused on nurses, assistive personnel, physicians, and other traditional healthcare providers. Families and caregivers are increasingly better informed about their loved one’s health care and should be educated about pressure ulcer prevention as well. Often it is the family or caregiver that is present at the bedside offering an opportunity to educate about pressure ulcer prevention, promoting collaboration to learn about the causes of pressure ulcers, and learning how to identify factors that increase risk of developing a pressure ulcer. The patient and caregiver are often actively involved in their own care and treatment. Patient and family centered education helps promote their own understanding of pressure ulcer prevention, options for care, and benefits of preventing pressure ulcers.
		
				The National Pressure Ulcer Advisory Panel (NPUAP) advises organizations to develop an action plan to educate patients, their families, and caregivers. Simple teaching tactics may include identification of signs of pressure ulcers, maneuvers to offload pressure by repositioning, monitoring nutritional intake for adequacy, and identifying skin health problems. Pressure ulcer prevention education can be incorporated during patient care treatments while the family members are present which may allow for return demonstration and discussion to review information learned. 
		
				I invite you to share stories about the efforts you and your organization use to educate patient’s, their families, and caregivers about pressure ulcer prevention in all health care settings. Sharing your examples will help others obtain ideas about patient and caregiver/family education processes aimed at meeting the healthcare needs for many. As always, feel free to contact me at czamarripa@jcrinc.com.  
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					<pubDate>Wed, 02 Nov 2011 16:49:33 GMT</pubDate>
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					<title>Pressure Ulcer Prevention Team Development - 5th in a Series: Assistive Personnel as Your First Line</title> 
					<link>http://www.jcrinc.com/Blog/2011/10/25/Assistive-Personnel-as-Your-First-Line-Defense-in-Pressure-Ulcer-Prevention/</link> 
					<description><![CDATA[
		
				
						Assistive personnel (i.e., nursing assistants, patient care technicians) are key stakeholders in the work to prevent pressure ulcers. These are often the front-line personnel who have contact with the patient or facility resident in day-to-day practice and the numbers of interactions are numerous, and may be related to toileting, repositioning, bathing, and assistance with activities of daily living. During these interactions, the assistive personnel are provided several opportunities to inspect skin and/or converse with the patient about their perceptions of their skin condition. Because of this interaction, these employees can help the RN identify those patients that are at high risk for developing a pressure ulcer or have an actual alteration in skin integrity. It is critical that the assistive personnel communicate directly with the RN to report the findings so the RN can ensure a focus on addressing individualized skin care and PUP needs. This interaction and communication between assistive personnel and RNs is important when establishing an individualized plan of to protect skin and prevent pressure ulcers. 
		
		
				
						 
				
		
		
				Do you include assistive personnel as a member of your PUP team? If you do include assistive personnel, how do they function on the team and how are responsibilities communicated and shared? If your PUP team does not include assistive personnel, do you plan to consider inviting them to join the team? What are some creative ways that you have developed teamwork and how have you educated assistive personnel on pressure ulcer prevention strategies? I would very much like to hear your thoughts and comments about the inclusiveness of assistive personnel in PUP teams. I can be reached via email at czamarripa@jcrinc.com and, as always, I look forward to hearing from you. 
		
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					<pubDate>Tue, 25 Oct 2011 16:49:43 GMT</pubDate>
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					<title>Pressure Ulcer Prevention Team Development- 4th in a Series: </title> 
					<link>http://www.jcrinc.com/Blog/2011/9/20/Pressure-Ulcer-Prevention-Team-Development-4th-in-a-Series-/</link> 
					<description><![CDATA[
		Optimal nutrition is considered basic to the management of health. The relationship between nutrition, skin health, pressure ulcer prevention (PUP), and wound healing should be considered fundamental to PUP practices. Anything less than optimal nutrition may place skin health at risk and/or further compromise healing. In order to promote nutritional support education and nutrition health best practices, the nutritionist should be included in the PUP team to provide guidance about practices to avoid and improve malnourishment. The nutritionist can offer expert guidance about diseases such as diabetes and how nutrition may help maintain glucose control through proper intake therefore enabling the body to heal and promote tissue healing or prevent further tissue breakdown. Additional contributions the nutritionist can offer is expert opinion and guidance to develop guidelines focused on maximizing nutrition for optimal wound healing and helping maintain adequate nutrition to help prevent pressure ulcers. Does your PUP team include the expertise of a nutritionist? How does your facility utilize the nutritionist in developing a comprehensive PUP program? I am interested in hearing about PUP team development and practices to correct nutritional deficiencies at your facility. I invite you to share your successes and as always, feel free to contact me at czamarripa@jcrinc.com for comments, questions, or suggestions about skin health.]]></description> 
					<pubDate>Tue, 20 Sep 2011 13:03:22 GMT</pubDate>
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					<title>Pressure Ulcer Prevention Team Development- 3rd in a Series: Physician Presence</title> 
					<link>http://www.jcrinc.com/Blog/2011/9/7/Pressure-Ulcer-Prevention-Team-Development-3rd-in-a-Series-Physician-Presence/</link> 
					<description><![CDATA[
		
		When planning the development of your Pressure Ulcer Prevention (PUP) team, it is imperative to engage the physician as a resource and liaison. The physician can offer support to help bridge the translation of established best practice PUP guidelines and care resources to the medical teams. The physician role should include collaboration between physician groups, families, and the PUP team. The physician responsibilities may also include assisting to develop the PUP program, communicate physician PUP practices or lack of knowledge related to PUP, and educate medical staff on importance of skin and risk assessment as part of the plan to prevent pressure ulcers. As you think about physicians in your organization, who would you approach to join the PUP team?My facility’s medicine service teams conduct unit based skin care rounds followed by discussion about the individual plan of care to prevent pressure ulcers. In addition, the physician rounding teams assess skin integrity to identify pressure ulcer presence for early detection and implementation of the individualized plan of care. Often the plan includes a consult to the WOC Nurse specialist followed by communication to discuss best practice options.  The physician presence helps strengthen the shared goal of optimizing quality of care for patients. I am interested in hearing about your successes as well as challenges in recruiting physicians to your PUP team. Maybe your story will help others learn more about approaches to develop physician partnerships. These collaborations are valuable to share as we work together to improve patient care and prevent pressure ulcers. As always, I invite you to contact me with any questions or requests for assistance in your quest to prevent pressure ulcers. Please feel free to contact me at czamarripa@jcrinc.com.]]></description> 
					<pubDate>Wed, 07 Sep 2011 15:31:14 GMT</pubDate>
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					<title>Pressure Ulcer Prevention Team-2nd in a Series: Leading the Team</title> 
					<link>http://www.jcrinc.com/Blog/2011/8/11/Pressure-Ulcer-Prevention-Team-2nd-in-a-Series-Leading-the-Team/</link> 
					<description><![CDATA[
		Behind every strong, well functioning team is a strong leader or group of leaders. Developing your pressure ulcer prevention (PUP) team requires leadership to help coordinate the team, partnering with the members to collaborate on a plan and mechanisms involved to develop and promote PUP programs.  It is important to identify leadership who is professional, knowledgeable, competent, and provides expertise in the prevention pressure ulcers. Other qualities to consider are leaders with vision to lead the team envisioning innovative approaches to PUP, providing guidance and support to members of the team, as well as a leader who works collaboratively to be inclusive of all voices and expertise of the team members.  Examples of a PUP team leader would be a Wound, Ostomy, and Continence Nurse, nurse manager, nurse educator, or any health professional that is a clinical expert to guide the development and delivery of optimal PUP programs. Who is on your team and who is identified as your PUP team leader?  Do you have success stories to share about your PUP team development? Are you starting a new team and would like to talk one on one to help guide you in the process? As always, I invite you to contact me with any questions or requests for assistance in your quest to prevent pressure ulcers. Please feel free to contact me at czamarripa@jcrinc.com. ]]></description> 
					<pubDate>Thu, 11 Aug 2011 14:39:48 GMT</pubDate>
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					<title>Developing a Pressure Ulcer Prevention Team - 1st in a Series</title> 
					<link>http://www.jcrinc.com/Blog/2011/7/18/Developing-a-Pressure-Ulcer-Prevention-Team-1st-in-a-Series/</link> 
					<description><![CDATA[
		Pressure ulcer prevention and identifying strategies to implement a pressure ulcer prevention program is a priority and important in our work to promote patient safety. In the webinar last week, I mentioned the Joint Commission Resources (JCR) Pressure Ulcer Prevention Program (PUPP) Assessment Survey. The survey is part of the pressure ulcer prevention (PUP) project that JCR and Hill-Rom have partnered to improve pressure ulcer prevention and their programs. The survey is aimed at helping you review your hospital program through the inventory assessment and identify elements you may very well already have in place or you may need to improve on to implement a comprehensive PUPP. I have personally completed the survey for our organization and found it helpful to download the survey questions first then review them with your team. There are about 40 questions addressing various aspects about the structure of your PUPP’s.  There are specific questions about your PUP team members, for example, who is identified as the executive champion and who comprises shareholders in your (PUP) team? The survey can be found and accessed through the JCR PUP project webpage at http://www.jcrinc.com/PUPP-Hospital-Assessment/. Please do visit the website, complete the survey, and at your request, I will contact you to review the survey results. As always, feel free to email me for any questions or comments about the project at czamarripa@jcrinc.com. 
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					<pubDate>Mon, 18 Jul 2011 19:57:04 GMT</pubDate>
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					<title>Pressure Ulcer Prevention Team Development - Thinking Big Starting Small</title> 
					<link>http://www.jcrinc.com/Blog/2011/7/6/Pressure-Ulcer-Prevention-Team-Development-Thinking-Big-Starting-Small/</link> 
					<description><![CDATA[
		This past week we had a chance to hear ideas about moving forward in developing and implementing a pressure ulcer prevention team. I wanted to take this opportunity to invite you to further discuss and dialogue about the proposed steps and recommendations to implement an effective team. I think we all agree there are many common barriers and gaps in implementing pressure ulcer prevention programs. The development of a structures team helps drive the success of steps to implementing a successful program for pressure ulcer prevention. How has your organization succeeded to implement and developed a successful pressure ulcer prevention team?  What steps has your organization taken to decrease the occurrence of pressure ulcers? Again, I invite you to ask questions, share your ideas, and tell us about your experiences in developing a successful team as we work to prevent pressure ulcers across all settings. After viewing the webinar slides and presentation, do you have any discussion points you would like for me to elaborate? All ideas and suggestion are important no matter how small. Remember, “Think Big, Start Small”! And as always, you are welcome to email me at czamarripa@jcrinc.com. 
		 
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					<pubDate>Wed, 06 Jul 2011 22:29:42 GMT</pubDate>
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					<title>Providing Safe Handoffs Through Optimal Communication</title> 
					<link>http://www.jcrinc.com/Blog/2011/6/17/Providing-Safe-Handoffs-Through-Optimal-Communication/</link> 
					<description><![CDATA[
		Providing a safe and comfortable transport of patients throughout the hospital and between departments requires optimal communication. Receiving a simple report about critical components necessary to keep a patient safe while in the temporary hands of other departments are an imperative step to achieving safety. How does your facility ensure effective communication between handoffs? Do all patients receive a “ticket to ride” when reporting off to other department staff? What do you consider important components in reporting to receiving staff? Does the handoff report include pressure ulcer risk and/or presence of pressure ulcer? I am interested to hear about your current “handoff” practices or plan to improve and promote safe handoffs. I invite you to comment right here on the website or as always, you can contact me at czamarripa@jcrinc.com. ]]></description> 
					<pubDate>Fri, 17 Jun 2011 17:13:15 GMT</pubDate>
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					<title>Poster Presentations Highlight Pressure Ulcer Prevention</title> 
					<link>http://www.jcrinc.com/Blog/2011/6/8/Poster-Presentations-Highlight-Pressure-Ulcer-Prevention/</link> 
					<description><![CDATA[
		
				Pressure Ulcer Prevention Projects were the focus of numerous poster presentations at the WOCN conference today. Our own Michael Willis, JCR/Hill-Rom project site leader for Beth Israel Medical Center presented, A Nurse-Driven Skin Saver Pilot Performance Improvement Project: Collecting and transforming data into quality. The poster outlined the process of how unit-based pressure ulcer prevention teams play a pivotal role in data collection and sustaining best practice ideas at the bedside. You can access the poster for further information at http://wocn.confex.com/wocn/2011am/webprogram/Paper6011.html.
		
				Additional poster abstract information including my presentation titled Identifying and Assessing The Elements For a Successful Pressure Ulcer Prevention Program (PUPP) and a coauthored presentation titled Targeting & Simplifying Risk Assessment & Interventions to Eliminate Hospital Acquired Pressure Ulcers can be found at http://wocn.confex.com/wocn/2011am/webprogram/Paper6145.html or http://wocn.confex.com/wocn/2011am/webprogram/Paper6152.html. 
		
				As before, I encourage you to respond right here on the blog or contact me with comments, ideas, and practice successes at czamarripa@jcrinc.com.
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					<pubDate>Wed, 08 Jun 2011 16:15:47 GMT</pubDate>
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					<title>Excerpts From the WOCN 43rd Annual Conference</title> 
					<link>http://www.jcrinc.com/Blog/2011/6/7/Excerpts-From-the-WOCN-43rd-Annual-Conference/</link> 
					<description><![CDATA[
		Greetings from the exciting and culture filled city of New Orleans! The WOCN conference consistently provides many opportunities to meet and network with fellow professional leaders in wound, ostomy, and continence care. The venue is a vehicle for exploring current practices, research findings, case studies, health care reform, health policy, and professional practice to name a few.  The conference sessions include the topic of pressure ulcer prevention (PUP) strategies, innovative care practices and addressing challenges in PUP. Exhibitors are included in providing information about the latest products and technology to prevent pressure ulcers. Educational opportunities offered by industry include Hill Rom’s Advancing Safe Skin throughout the Care Continuum with clinical resources available through www.hill-rom.com/2011WOCN. My colleagues and I agree the session topic about Preparing for the Future clearly represents the professions need to understand how the 2010 Affordable Care Act is important to understand. This legislation will impact the delivery of health and more specifically pressure ulcer prevention as we partner with all stakeholders to serve our patient populations.  Being involved in public policy will help achieve the goals of our clinical work and professional practice. Meet me here again tomorrow. I look forward to sharing further learning opportunities and as always, feel free to respond right here on the blog or contact me with comments, ideas, and practice successes at czamarripa@jcrinc.com.]]></description> 
					<pubDate>Tue, 07 Jun 2011 16:19:51 GMT</pubDate>
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					<title>At the WOCN in New Orleans</title> 
					<link>http://www.jcrinc.com/Blog/2011/6/8/At-the-WOCN-in-New-Orleans/</link> 
					<description><![CDATA[
		
		I hope you are enjoying the 43rd annual Wound, Ostomy and Continence Nurses Conference in New Orleans.  We are fortunate this year to have our Nurse Safety Scholar, Cecilia Zamarripa, present a poster (#5224).  It reviews the elements of a successful PUPP.  In addition, Cece will have a second poster (#5219) presenting information about the use of a risk assessment tool to prevent PU.  Michael Willis, a CWOCN, who is a site leader for our JCR-Hill Rom project will also present two posters (#5288 and #5289).  His posters offer information about use of the electronic health record in the emergency department to document Present on Admission PU and use of the Skin Saver pilot and data use. Please find some time to review the posters by Cecilia and Michael.  Both of these participants will be eager to discuss their projects]]></description> 
					<pubDate>Mon, 06 Jun 2011 16:10:16 GMT</pubDate>
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					<title>Read All About It</title> 
					<link>http://www.jcrinc.com/Blog/2011/6/2/Read-All-About-It/</link> 
					<description><![CDATA[
		
				Pressure ulcers and their prevention continue to be a quality and safety focus. I invite you to read the published work of our former nurse scholar Irene Jankowski and Deb Nadzam, JCR Project Director, AHRQ Knowledge Transfer/Implementation. In this article, you will find information about safety focused best practices associated with pressure ulcer prevention.  Enjoy the reading, I did!
		
				
				Jankowski I.M., Nadzam D.M.: Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs. Jt Comm J Qual Patient Saf 37:253-264, Jun. 2011.
		
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					<pubDate>Thu, 02 Jun 2011 15:01:11 GMT</pubDate>
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					<title>Getting the Grade</title> 
					<link>http://www.jcrinc.com/Blog/2011/5/24/Getting-the-Grade/</link> 
					<description><![CDATA[
		
				
				You may have heard about the healthcare ratings reported by HealthGrades, an independent health care ratings organization. The ratings report is available via the Internet and provides selective information such as comparisons of hospitals, profiling physicians, and offering reports for several varieties of medication costs. Recently, HealthGrades has been in the news highlighting studies and statistics made available including hospitals and patient safety. For more news information and to read about the media’s reporting on HealthGrades, go to: http://www.healthgrades.com/business/news/
		What you may find on the instant reports are patient safety events including pressure ulcer acquired in the hospital as well as HealthGrades awards and ratings.  Access to reported information starts with a user agreement on the “Find a Hospital” link where you enter the hospital name, city, and zip code to locate. Once you locate the facility, click on the facility name, then click on patient safety ratings, scroll down to patient safety indicator to read what is being reported on pressure ulcers acquired in the hospital. According to the website link information, the ratings “reflect the quality of care at a hospital by measuring how well the hospital prevents potentially avoidable complications and adverse events following surgeries and procedures”.  It is interesting to also note, the rating names of better, average, or worse, are based on comparison of expected number of events for that hospital facility. You will find several patient safety indicators rated and included in the reports. The home page can be found at http://www.healthgrades.com/.
		
				Take a look, see how your hospital rates and compare the ratings to your hospital’s pressure ulcer prevalence and incidence reports. I would be interested to hear how well it matches. Let me know your thoughts and findings about HealthGrades.  I look forward to hearing from you! 
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					<pubDate>Tue, 24 May 2011 19:53:11 GMT</pubDate>
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					<title>Pressure Ulcer Prevention - Resources for Learning</title> 
					<link>http://www.jcrinc.com/Blog/2011/5/4/Pressure-Ulcer-Prevention-Resources-for-Learning/</link> 
					<description><![CDATA[
		I had the opportunity to attend the National Pressure Ulcer Panel (NPUAP) 2011 conference February 25-26 and I would like to share some of the highlights presented by the conference speakers.  Attending this conferences provided information from experts in pressure ulcer prevention research, education, and public policy.  The keynote speaker Dr. Ayello presented the New Jersey Hospital Association statewide collaborative to reduce pressure ulcers across multiple settings. The components of the collaborative are explained on power point available on the NPUAP website. The initiative theme was, “You need a partnership to save skin”. In 2011, there will be a 200-page toolkit booklet available. The booklet details ideas for PUP initiatives. The booklet was done as a project sponsored by the Agency for Heathcare Research and Quality (AHRQ) in conjunction with the Department of Veterans Affairs. Dr. Ayello’s presentation details can be accessed through the NPUAP.org website as well. In addition, the National Database of Nursing Quality Indicators (NDNQI) Update included information about the history of NDNQI data collection on the pressure ulcer outcome indicator, data collection on pressure ulcers, hospital acquired pressure ulcers (HAPU). 2010 NDNQI data extracted from 1st and 2nd quarters revealed rates in various adult unit types compared to 2004 2nd and 3rd quarter, and 2006-2007 4th and 1st quarter HAPU rates.  The number of Critical Care HAPU’s increased as the number of beds increased, HAPU's are declining in step down units and the proportion of Suspected deep tissue injury (sDTI) has increased. Further detailed information is available.Other learning includes Clinical Update on MDS 3.0 Section M Skin ConditionsStaging Challenges: Avoidable vs. Unavoidable Pressure Ulcers.Consensus from 2010 was reviewed as well. Consensus Panel Meetings were held and much of the discussion was on root cause and common cause analysis at the patient level. Several breakout discussions were held prior to returning to meet for consensus voting. There was also discussion about sDTI being categorized as a "pressure injury". Another brief discussion included whether Kennedy Terminal Ulcer should be classified as manifestation of skin failure. 
These were some of the highlights, there is much more on the NPUAP website and I encourage you to read more about the conference presentations. As always, I welcome your thoughts and encourage any discussion about your readings and work in pressure ulcer prevention.]]></description> 
					<pubDate>Wed, 04 May 2011 17:36:22 GMT</pubDate>
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					<title>And the Survey Says!</title> 
					<link>http://www.jcrinc.com/Blog/2011/4/8/And-the-Survey-Says/</link> 
					<description><![CDATA[
		
				
				You may have noticed JCR has implemented several projects to focus on translating safe patient care practices from evidence to the bedside. One such project is the JCR and Hill-Rom Pressure Ulcer Prevention Project (PUPP) assessment tool used to review hospital assessment programs and identify pressure ulcer prevention (PUP) program elements in place as well as identifying program gaps within the organization. 
		
		
				The survey questions can be downloaded so that organization members completing the survey can review the questions with their staff in preparation for submitting answers. The survey questions focus on organizational support, PUP protocols and guidelines, and equipment and supplies used to prevent pressure ulcers. Additional questions address staff education about PUP and provision of related information to the patient/family, handoff communication, and measurement reporting of pressure ulcer prevalence and incidence. To access the survey, visit this page: 
				
						http://www.jcrinc.com/PUPP-Hospital-Assessment/
				
				. I would like to invite and encourage you to complete the survey assessing your hospital’s PUP program and receive the benefit of help in identifying program gaps and barriers as well as excellence in your PUP programs to be shared with other organizations. Organizations are encouraged to review their program results with the current Nurse Safety Scholar-in-Residence who can be reached at 
				
						CZamarripa@jcrinc.com
				
				.  
		
		
				To date, 52 organizations have completed the survey with plans to encourage and invite additional organizations to utilize the survey in assessing their hospital program. One current plan in progress is to link participants of the 2011 Hill-Rom International Pressure Ulcer Prevalence Survey to the PUPP Hospital Assessment, so if you were a participant in the Hill-Rom survey, you will be contacted within the next few weeks encouraging your participation. 
		
		
				We hope to hear from you soon and invite you to share the program information with your organization, contact me (Cece) and learn more about how your organization’s PUP compares to other programs. In addition, there is no charge for completing the assessment survey and/or access to the Nurse Safety Scholar. We look forward to hearing from you and helping you access tools and best practices to maintain skin integrity and prevent pressure ulcers.  
		
		
				Cece
		
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					<pubDate>Fri, 08 Apr 2011 13:18:22 GMT</pubDate>
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					<title>Working Together to Save Skin</title> 
					<link>http://www.jcrinc.com/Blog/2010/12/7/Working-Together-to-Save-Skin/</link> 
					<description><![CDATA[
		
				
						It is with an enormous sense of respect and pride that I step into the role of Nurse Safety Scholar in Residence. My predecessors Irene and Diane, both dynamic leaders, have laid a foundation for practices we can build upon, stimulating inquiry related to nursing practice and guidance toward the common goal of preventing pressure ulcers.  Whether it is determining turning frequency or encouraging utilization of experts in the prevention and treatment of pressure ulcers, we have been provided an impetus to move forward and focus on the primary practice of preventing pressure ulcers in every health care arena. 
		
		
				Determining optimal turning frequency and collection of data from the project sites is logical to build upon since most pressure ulcers are caused by exposure to tissue loads, especially prolonged pressure. 
		
		
				Other challenges that remain are the fact that the cause of pressure ulcers is multi-factorial and the populations of the people we serve often have multiple co-morbidities. The population is also diverse and we are challenged to develop practices congruent with the individual’s cultural care needs. 
		
		
				I concur with Diane’s statement that “Further research needs to be conducted in order to draw scientific conclusions on turning intervals,” but this leads to another question, “Are patients actually being turned?”
		
		
				We are all challenged and stimulated to conduct or participate in research to provide evidence for best practices.  
		
		
				As Diane proposed, “Where do we go from here?” We must continue to build on the foundation that has been laid ensuring quality pressure ulcer prevention practices are developed, shared, implemented, and evaluated in our quest to providing safe and quality care. I look forward to the future and communicating with you about any ideas or knowledge contributions you may share. 
		
		
				Cece
		
]]></description> 
					<pubDate>Tue, 07 Dec 2010 19:26:02 GMT</pubDate>
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					<title>Conference Notes and Turning Schedules</title> 
					<link>http://www.jcrinc.com/Blog/2010/10/14/Conference-Notes-and-Turning-Schedules/</link> 
					<description><![CDATA[
		
				
						Attending the national conference (Clinical Symposium on Advances in Skin & Wound Care) is always an exciting endeavor and presenting this year enhanced the experience. Being among my colleagues to discuss issues that are so relevant to our practice, and learning about new research studies enables me to broaden my knowledge. In turn, sharing this knowledge generates even more discussion and feedback, and contributes to a higher quality of care for our patients.
		
		
				During this conference, I attended two outstanding presentations on turning. Since turning practices were identified as opportunities by all four hospitals involved in the Pressure Ulcer Prevention Project (PUPP), I wanted to share some key points from conference and combine that with some of the findings from our site visits.
		
		
				For years pressure ulcer prevention guidelines have included recommendations to turn patients at least every two hours, but there is little evidence to support this time interval. In one presentation by Dr. Barbara Bates-Jensen, she sites three studies where development of pressure ulcers were decreased in patients on a four-hour turning schedule when combined with viscoelastic foam mattresses, as compared to a standard hospital mattress and a two hour turning schedule. Dr. Bates-Jensen continued on to discuss other variables in turning including the 30 degree tilt or 90 degree lateral side lying position, proning and head of bed elevation. 
		
		
				Dr. Vivian Wong presented an oral abstract on skin blood flow (transcutaneous oxygen or TcO2) response to a two-hour repositioning schedule. Her study looked at blood flow changes in clients placed supine for two hours and in a lateral position for two hours. All patients were on a standard hospital mattress. The results demonstrated a lowered sacral oxygenation to below 40mmhg, in some subjects, regardless of whether there was adequate Tc02 prior to the turn. This suggests that even a two-hour turning schedule might not be adequate without additional interventions.
		
		
				So, where do we go from here? Is turning and repositioning required every two, three or four hours? Further research needs to be conducted in order to draw scientific conclusions on turning intervals, but this leads to another question: Are patients actually being turned?
		
		
				Do we reposition patients on any turn interval? One of the facilities involved in the PUPP began a turning surveillance survey to look at this issue. Seeing the importance of such a survey, all four sites helped modify the survey tool and added guidelines to standardize the process. The survey involved staff making rounds and documenting patient’s position, followed by two more rounds at two-and-a-half-hour intervals.  The sites’ combined percentage of patients who were turned was 70.6%. Criteria for patients needing to be turned are described in the guidelines. This left 20% of the patients not turned as scheduled! At the conclusion of the survey, nursing staff were interviewed and asked to identify barriers that prevented patients from being turned. This information is crucial to understanding the complexities involved in turning schedules, which include availability of staff, time involved, necessary equipment, unstable patients, compliance and goals of care.
		
		
				
				The project sites are continuing to survey turning practices and will be sharing these data with you. What are some of the issues you encounter with turning protocols, and are you currently surveying turning compliance rates as part of your process data collection? 
		
		
				
						
						Download Turning Survey Tool and Guidelines
						
						Diane Whitworth, CWOCN
		
]]></description> 
					<pubDate>Fri, 15 Oct 2010 05:49:34 GMT</pubDate>
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					<title>Congratulations to Diane Whitworth, RN, CWOCN</title> 
					<link>http://www.jcrinc.com/Blog/2010/9/30/Congratulations-to-Diane-Whitworth-RN-CWOCN/</link> 
					<description><![CDATA[
		
				
				Congratulations to Diane Whitworth, RN, CWOCN, JCR’s Nurse Safety Scholar-in-Residence, for being selected to present at the Clinical Symposium on Advances in Skin & Wound Care, September 30 – October 3 in Orlando, Florida. Ms. Whitworth is a Wound Ostomy and Continence Nurse at Bon Secours St. Mary’s Hospital in Richmond, Virginia where she is responsible for her organization’s Wound Care Team.
		Diane’s presentation, titled “EBP and Pressure Ulcer Prevention:  What are the Gaps/Barriers?”, will discuss the JCR and Hill-Rom Pressure Ulcer Prevention Project process and findings.  A poster presentation detailing the issues and solutions for preventing pressure ulcers will also be available.
		
				Look for Diane during session #122, 1:30 PM, October 1, 2010.
]]></description> 
					<pubDate>Wed, 29 Sep 2010 20:25:44 GMT</pubDate>
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					<title>Education - Bridge to Prevention</title> 
					<link>http://www.jcrinc.com/Blog/2010/8/27/Education-Bridge-to-Prevention/</link> 
					<description><![CDATA[
		
				
						
						Common gaps identified in all four project sites involve the education of the care delivery team in Pressure Ulcer Prevention. I use this term purposefully to capture not only the RN’s role, but also the interdisciplinary staff roles responsible for the production, or in this case, the positive outcomes. A critical component of pressure ulcer prevention is making sure the right information is available to all health care providers, patients, families and caregivers. Identified gaps in care include the role of the physician, patient care assistants (PCA) or techs, ancillary services and surgical services. While some of these roles overlap, each group recognized barriers to care. Some strategies to overcome these barriers are outlined.
		
		
				One facility focused on the role of the physician and designed an educational and informative pocket guide. This guide provided physicians with a quick reference on skin integrity assessment, pressure ulcer risk factors, staging pressure ulcers (we can all relate to this challenge), documentation strategies, and management recommendations. Not only did this guide help physicians, but reinforced their role in prevention. (Download the guide: Pressure Ulcer Physician Pocket Guide)
		
		
				
						PCAs or techs have historically not been included in PUP education. As front-end providers of patient care, valuable pieces of information have been ignored or overlooked due to this omission. Encouraging and enlisting PCAs to be part of the Skin Saver Team empowers them to be proactive champions of PUP. Let’s review a frequent scenario: A RN performs a Braden Risk Assessment and identifies a patient with a low subscale, under Nutrition. This triggers a dietary consult. The dietician assesses and makes a recommendation to increase protein intake. Protein supplements are delivered to the room, and then what? Who is responsible to ensure the patient eats the high protein food, or consumes the supplement? Is the PCA knowledgeable about what foods are higher in protein? When a PCA states a patient ate 50% of their meal, was this the mashed potatoes, rolls and dessert? 
		
		
				In facilities where PCAs are members of the Skin Saver Team, they are equipped with the knowledge to inform and motivate patients about their diet. In turn, they can relate this information back to the nurse. 
		
		
				Please share what is working in your facility. How have you involved other care team members in PUP?  Do you feel roles and responsibilities are clearly defined? I welcome your comments, suggestions, recommendations and questions. 
		
		
				
						Diane Whitworth, CWOCNLearn more about the Pressure Ulcer Prevention Project
		
]]></description> 
					<pubDate>Fri, 27 Aug 2010 07:30:04 GMT</pubDate>
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					<title>Beginning My Journey as Nurse Safety Scholar</title> 
					<link>http://www.jcrinc.com/Blog/2010/7/29/Beginning-My-Journey-as-Nurse-Safety-Scholar/</link> 
					<description><![CDATA[
		
				Assuming my role as Nurse Safety Scholar has been both challenging and very rewarding. Meeting and working with the JCR-Hill-Rom steering committee has been a privilege. Their commitment to patient safety and health care quality is inspiring, and their dedication and focus is unrelenting. Irene, I cannot thank you enough for your guidance and friendship. What a remarkable WOCN you are!
		As a wound ostomy and continence nurse for greater than 20 years, I have experienced firsthand the remarkable strides we have achieved in pressure ulcer prevention. From Maalox and heat lamps, to turn teams and microclimate redistribution mattresses, we continue to advance care by incorporating new evidence-based practices and technologies. However, for this evidence to be applicable and hardwired, we must ensure that health care providers, at every level, are using the evidence to improve patient care.
		This is where my journey as the Nurse Safety Scholar begins.Diane Whitworth, CWOCNLearn more about the Pressure Ulcer Prevention Project
]]></description> 
					<pubDate>Fri, 30 Jul 2010 03:00:02 GMT</pubDate>
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					<title>Lessons Learned</title> 
					<link>http://www.jcrinc.com/Blog/2010/3/4/Lessons-Learned/</link> 
					<description><![CDATA[
		
				
						
						
						My final month as the JCR/Hill-Rom Nurse Scholar is here and I leave this project with a greater appreciation for the hard work that nurses and nursing assistants do every day as they provide the best possible care for their patients. Every day, nurses all over the world are faced with more and more responsibilities. Nurses work hard to protect patients from misinformation, infections, wrong medications, wrong tests, falls, pressure ulcers and more. At the same time they constantly assess patients' responses to all sorts of illnesses, medications and treatments.  
				
		
		
				
						
								 
						
				
		
		
				
						For the past year I have had the privilege of working with amazing nurses who have focused on making sure that patients are protected from pressure ulcers. Four different hospital systems have participated in this project, which began with the idea that there may be some barriers and gaps to implementation of existing pressure ulcer programs.  
				
		
		
				
						
								 
						
				
		
		
				
						Here are just a few of the lessons learned: 
				
		
		
				
						
								 
						
				
		
		
				
						
								Pressure Ulcer Prevention (PUP) Programs
						
				
		
		
				
						The information gained from risk assessments is not used to develop the prevention plan. Risk scores are not routinely passed on in hand-offs. Doctors never heard of Braden. Why? Shouldn't they know if their patients are at risk for pressure ulcers?
				
		
		
				
						
								 
						
				
		
		
				
						Tracking patients that are at risk for pressure ulcers revealed that patients, as they move throughout the hospital for testing, dialysis, and procedures, may spend a significant amount of time on stretchers in the care of transport staff and other ancillary technicians. However, most PUPs only educate nursing staff about prevention interventions. High-risk patients may be positioned on thin stretcher mattresses in one position for periods of four hours and more. Should pressure ulcer prevention information be provided to other departments besides nursing?
				
		
		
				
						
								 
						
				
		
		
				
						A sample action plan taken from the various sites shows the progression from identification of the gap/barrier to implementation of the solution.  
				
		
		
				
						
								 
						
				
		
		
				
						
								Gap: 
						
						Limited education for Patient Care Associates (PCA) related to the PUP program. (Although PCAs routinely provide bedside patient care, they were not included as members of the Pressure Ulcer Prevention Committee.)
				
		
		
				
						
								 
						
				
		
		
				
						Problem was identified after a survey of PCAs revealed their interest in learning more about the hospital's PUP program.
				
		
		
				
						
								
										 
								
						
				
		
		
				
						
								Next steps: 
						
						Create learning objectives, select the education method, determine frequency of education, confirm which PCAs will be taught, deliver the education, measure the effectiveness using a post-education test.
				
		
		
				
						
								
										 
								
						
				
		
		
				
						
								Gap: Pressure ulcer prevention for patients with extended stays in the ED. One hospital noted that there is a backlog of patients in the ED awaiting transfer to med/surg units. The high-risk patients were on standard stretcher mattresses and repositioning was challenging due to the narrow widths of the stretchers.  
				
		
		
				
						  
				
		
		
				
						
								Next steps: Due to the number of high-risk patients, arrangements were made to purchase new stretchers with pressure redistribution mattresses. In addition, education was provided for the ED staff related to identification of high-risk patients and interventions that would promote pressure ulcer prevention. 
				
		
		
				
						  
				
		
		
				
						Other gaps in prevention include delays in nutritional support for extended periods of time when patients are NPO waiting for tests to be completed; using the nutrition score on the Braden tool as a trigger for nutrition consults, which leads to unnecessary nutrition consults due to incorrect scoring and assumptions that nurses are aware of all resources for prevention; confusion about how to use skin care products, lift equipment, special beds and more. 
				
		
		
				
						  
				
		
		
				
						A survey of turning practices revealed that nurses’ perceptions of actual turning times may not reflect the actual turning. 
				
		
		
				
						  
				
		
		
				
						There is much more work to be done! Good news! This project has been extended for an additional six months. JCR and Hill-Rom will be introducing the new JCR/Hill-Rom Nurse Scholar on April 1, 2010.  I will be able to stay connected to this project since my own facility, Beth Israel Medical Center in New York, New York, is one of the participating hospitals. I look forward to the next six months and the opportunity to pass on what we are learning to the nursing community. 
				
		
		
				
						
						
				 
		
				
						
								 
						
				
		
		
				
						Keep them turning, 
				
		
		
				
						Irene 
				
		
]]></description> 
					<pubDate>Thu, 04 Mar 2010 06:33:41 GMT</pubDate>
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					<title>Diagnosing a pressure ulcer: Barrier to prevention?</title> 
					<link>http://www.jcrinc.com/Blog/2010/1/13/Diagnosing-a-pressure-ulcer-Barrier-to-prevention/</link> 
					<description><![CDATA[
		
				
						Diagnosing a pressure ulcer: Barrier to prevention?
						
				
		
		
				Correctly diagnosing a pressure ulcer can be complicated. In fact there are times when even the wound care experts are unsure of the etiology of a wound, causing debate over whether or not to refer to a wound as a pressure ulcer. Questions arise when a clear history of the wound is not obtainable, or when wounds over the sacrum and heels appear despite careful attention to using pressure ulcer prevention techniques like repositioning, special mattresses, nutritional support, etc. Are these wounds the result of cardiovascular problems that effect tissue perfusion or obstruction of a blood vessel? Are these wounds an inevitable sign of impending death as is proposed in discussions of Kennedy terminal lesions. At times skin loss that is actually due to incontinence-associated dermatitis as well as a variety of other dermal skin lesions may be wrongly diagnosed as pressure ulcers. Further confusion has arisen as the debates continue regarding the differences between the Category 1 – Stage 1 pressure ulcers versus deep tissue injuries.  
		
		
				At this point checking for blanching is the diagnostic method for diagnosing Category 1-Stage 1 pressure ulcers. Medical devices that may assist with pressure ulcer diagnosis are not readily available. Some facilities use the skills of the wound specialists to assess all pressure ulcers in an attempt to promote accurate diagnosis as much as is possible with an understanding that there are still so many unanswered questions about cause and effect of pressure ulcers. What are the implications of making the wrong diagnosis? What is the impact on the collection of quality data? Please share your thoughts about this issue with colleagues. I look forward to your comments.
		
		
				
						Keep those patients turning.Irene
		
		
				
						
						
						
				
		
]]></description> 
					<pubDate>Wed, 13 Jan 2010 15:08:32 GMT</pubDate>
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					<title>The Physician&amp;quot;s Role in Preventing Pressure Ulcers</title> 
					<link>http://www.jcrinc.com/Blog/2009/10/16/The-Physicians-Role-in-Preventing-Pressure-Ulcers/</link> 
					<description><![CDATA[
		
				
						
						
						
				
		
		
				
						It is well accepted that doctors have a role in the treatment of pressure ulcers, but what about prevention? I’ve been reviewing various hospitals’ pressure ulcer prevention programs and am struck by what I see as an important team member who seems to be absent—doctors. Do doctors have a role in pressure ulcer prevention? Are doctors on your pressure ulcer prevention committees? I have been asking various nurses this question with some interesting responses.  I’ve also begun to ask doctors this question and have been surprised by some of their responses as well. Consider the steps that are outlined in most pressure ulcer prevention programs that require participation by doctors. For example, if the patient is malnourished, we know that nutritional supplementation is important and our programs recommend a nutrition consult. But who will order the nutrition consult and who will write the nutrition orders? Another example: who treats conditions that cause diarrhea, a risk factor that is associated with skin breakdown? While nurses are working to protect skin from breakdown, the doctor should be equally anxious to resolve the causes of the problem. Who writes orders for mobilizing patients? When a doctor orders bed rest, is he/she aware of the Braden score that may be identifying the patient as high risk for pressure ulcers? In fact, have nurses shared information about the Braden scale with doctors? I would like to hear about how the doctors in your facility are working together with nurses to prevent pressure ulcers.  
				
		
		
				
						
								 
						
				
		
		
				
						Best regards to all and keep them turning.  
				
		
		
				
						Irene
				
		
		
				
						
								 
						
				
		
		
				
						
								 
						
				
		
]]></description> 
					<pubDate>Fri, 16 Oct 2009 13:58:17 GMT</pubDate>
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					<title>Fall update: The project begins</title> 
					<link>http://www.jcrinc.com/Blog/2009/9/9/Fall-update-The-project-begins/</link> 
					<description><![CDATA[
		
				
						
				
				
						
								
										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
						
						
						
				
		
]]></description> 
					<pubDate>Wed, 09 Sep 2009 21:37:29 GMT</pubDate>
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					<title>July Update and Hospital Site Selection</title> 
					<link>http://www.jcrinc.com/Blog/2009/7/29/July-Update-and-Hospital-Site-Selection/</link> 
					<description><![CDATA[
		 
		 
		
				
						In just two weeks we will be entering the 4th month of this project. During the summer months we should be taking some time off and enjoying the weather and time with family. The importance of protecting patients from injuries never stops, no matter the season. Caring for hospitalized patients is a 24-hour, 7-day-a-week process, so prevention strategies have to carry over through night shifts, weekends and holidays. 
				
		
		
				
						This note is an update of what is happening so far and a little about where I hope this project is going. There have been some interesting questions, comments and ideas that have come up in many conversations with nurses. Does your staff know how to access a special bed on off hours? A number of nurses have told me about algorithms and protocols they have developed as a way to avoid delays in ordering products. These documents are helpful when staff is confused about what to order or the process of ordering is too complicated and requires a signature from an administrator or doctor. I heard today about a pressure ulcer prevention hand-off form being used at one hospital in order to make sure that information about patient protection from pressure ulcers is passed on from nurse to nurse. Do the nurses in your facility report their patients’ Braden scores? One favorite strategy being used in some hospitals is playing a short run of music every two hours during the daytime that will trigger staff to reposition patients – one song mentioned was “Turn, Turn, Turn.”  
				
		
		
				
						We have completed the selection process and four hospital systems will be working with us to refine their pressure ulcer programs by eliminating or, at least, minimizing barriers to implementing strategies for prevention. We are interested in hearing stories from the field about successes and challenges that you have experienced. More information about the participating sites will be shared soon. A selection of articles that may be of interest to the group will also be posted.  
				
		
		
				
						Keep the pressures low and Turn, Turn, Turn 
				
		
		
				
						Best regards, Irene 
				
		
		
				
						
						
				 
]]></description> 
					<pubDate>Wed, 29 Jul 2009 15:53:02 GMT</pubDate>
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					<title>Journey Update and Literature Review</title> 
					<link>http://www.jcrinc.com/Blog/2009/6/4/Journey-Update-and-Literature-Review/</link> 
					<description><![CDATA[
		 
		 
		
				
						I am just beginning my second month of this year-long project and am still trying to develop a good pace for working half-time as the WOCN for my hospital and working half-time on a project that I hope will find solutions to the barriers to success for pressure ulcer prevention programs. My hospital colleagues and new colleagues at Joint Commission Resources are amazingly supportive and I’m grateful for that much-needed support and guidance.
				
		
		
				
						
								 
						
				
		
		
				
						I am continuing with the review of the literature and have tried to focus primarily on finding articles that describe programs that show sustained improvements once all of the steps of the program have been initiated. I know that there are many such programs out there, and not everyone has published their results, so please send thoughts and comments to the blog. Every message is important.
				
		
		
				
						
								 
						
				
		
		
				
						I have much to learn about implementing a complicated program into complicated systems. First, there are 12 published guidelines geared specifically to prevention of pressure ulcers. All of these guidelines list similar interventions for prevention, e.g., repositioning, moisture control, nutrition and hydration, management of tissue loads, shear and friction. Most hospitals are using the NPUAP, NDNQI and WOCN recommendations to develop their programs. 
				
		
		
				
						
								 
						
				
		
		
				
						Second, there are many articles that describe quality improvement projects that showed a successful short-term impact on the problem, but only a few that discuss improvement for a year or more. Few of these articles discuss participation from other disciplines. I am beginning to see a parallel to the challenges that are faced by my Infection Control colleagues. The Infection Control Nurse also must implement protocols that touch all hospital employees and must achieve very strong compliance with interventions (such as hand washing) in order to protect patients from injuries. I was joking (half-joking) with a colleague about wanting to hire some wound care nurses to do surveillance techniques in order to make sure that patients were being repositioned frequently and that soiled diapers were being changed quickly. Not a very realistic solution – just a thought.  
				
		
		
				
						
								 
						
				
		
		
				
						Based on my reading, it seems that one of the critical factors to success is the support of executive level leadership. This is the time to make proposals for the purchase of appropriate equipment and other resources to the CEO, COO, CFO, and CNO. The cost of caring for patients with pressure ulcers will have a serious impact on the bottom line, so the support for prevention is strong. Every hospital’s mission is to provide safe care to patients and prevent avoidable injuries, whether pressure ulcers, other skin-related injuries, infections or falls.
						
						
				
		
		
				
						
								 
						
				
		
		
				
						In my meeting with the Steering Committee, I was able to outline some of the specific barriers/challenges and potential solutions. We talked about better training for nurses for completing risk assessments, making sure that our nutritionist’s recommendations are ordered by the doctors, challenges with teaching doctors and nurses the NPUAP staging system for accurate documentation, availability and appropriate usage of pressure redistribution surfaces, the challenge of making sure that prevention strategies continue even when the patient is off the nursing unit, on stretchers waiting for tests, in the OR, ED or on other units receiving treatments.
						
						
				
		
		
				
						
								 
						
				
		
		
				
						Hospital nursing departments are vigilant about making sure that there is a program in place for preventing pressure ulcers, but other disciplines must also be actively involved in this process. Also, it is not enough to have the plan on paper. A dedicated leader needs to be provided with the time and resources to manage the program and maintain the momentum and positive outcomes. Our goal is to work with a hospital’s existing program, identify the gaps, barriers and challenges and develop a program that will lead to sustained reduction in incidence of pressure ulcers. I will continue to read everything I can find about this topic and invite you to pass on any recommended reading. I understand that there are many groups grappling with this issue and am hoping that we can share information and resources as much as feasible. Thank you to colleagues working on the PUCI project for generously sharing information and conversation. I have also had the opportunity to sit in on a meeting with the GNYHA and IPRO in New York to hear about their projects.  
				
		
		
				
						
								 
						
				
		
		
				
						Once site selection for our project is completed, I will write another update to keep all interested bloggers informed. “Keep the pressures low.”
				
		
		
				
						
								 
						
				
		
		
				
						Best regards, 
				
		
		
				
						Irene
				
		
]]></description> 
					<pubDate>Thu, 04 Jun 2009 16:26:09 GMT</pubDate>
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					<title>The journey begins</title> 
					<link>http://www.jcrinc.com/Blog/2009/5/7/The-journey-begins/</link> 
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		As a bedside Wound, Ostomy, Continence Specialist, I am convinced that best practices for pressure ulcer prevention can be effective and can lead to prevention of most pressure related injuries. However, I am also aware that there are gaps in the prevention process, probably at the point of clinician/patient contact, that could lead to patient injury and that may interfere with achieving sustainable positive outcomes. During the coming months, I hope that we can identify these barriers, and design tools and programs that will address these issues and lead to improved patient safety.
		My orientation journey began with a visit to Batesville, Indiana, the headquarters of Hill-Rom, a global medical technology company. At Hill-Rom I had the opportunity to spend a day talking with various specialists including nurse consultants, biomedical engineers, scientists and statisticians about challenges related to the prevention of pressure ulcers in acute care facilities. A highlight of the visit was the opportunity to talk with the individual responsible for collation and analysis of the findings in the latest International Prevalence Survey. I expect that we will be having many interesting discussions about these findings over the coming months. 
		The next step in the orientation process was a visit to the headquarters of Joint Commission Resources (JCR) in Oak Brook, Illinois. At JCR I met with members of the Steering Committee who were involved in the scholar selection process and was introduced to a variety of nurse consultants who are specialists in implementation of patient safety initiatives. It was an amazing experience to be surrounded by so many thought leaders and experts who work toward the goal of excellence in patient care and who are in a position to truly influence bedside practice. I also met with individuals who are part of the international community, bringing state-of-the-art programs, education and consulting to health care institutions all over the world. My orientation was facilitated by Deborah Nadzam, PhD, FAAN, Practice Leader, Patient Safety Services, for JCR.  Deborah will be my mentor throughout this process.
		I must extend a thank you to the members of the JCR-Hill-Rom Steering Committee for selecting me for this amazing opportunity. I also thank my colleagues at Beth Israel Medical Center, especially Ms. Mary Walsh, RN, CNO, VP for Nursing and Betty Furr, Director of Quality Improvement, for encouraging me to apply for this position.
		This week I will focus on the literature review with a special interest in pressure ulcer program implementation gaps, barriers, and challenges for practitioners at the bedside trying to decrease hospital-acquired skin injuries. 
		Share your comments and suggestions with me and with others by participating in my blog. I look forward to reading and responding to your input. 
		Until next time, Irene Jankowski, MSN, APRN, BC, CWOCN
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					<pubDate>Thu, 07 May 2009 13:14:00 GMT</pubDate>
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