Reduction of Nosocomial Pressure Ulcers on 5 NEW Rehabilitation Unit

Reduction of Reduction of Nosocomial Pressure Nosocomial Pressure

Ulcers Ulcers on 5 NEWon 5 NEW

Rehabilitation UnitRehabilitation Unit

Save Our

Skin

Confidential: Quality Improvement Material

Team Membership

• Physicians• Acute Rehab Nurses• Skin Liaison Nurse• Patient Care Techs• Physical Therapists• Occupational Therapists• Administrative Assistant• Center for Clinical Effectiveness


National benchmarking data demonstrated an increase of hospital acquired pressure

ulcers on 5NEW.

•Documentation Issues•Nurses not consistently documenting skin assessment upon admission•No EPIC field to document healed ulcers

•Staff Issues•Need for increased education regarding appropriate toileting

•Patient Issues•Prolonged sitting in chairs•Wearing ill-fitted shoes

Problem Identified


Aim Statement

Reduce the incidence of nosocomial pressure ulcers on 5 NEW to zero.


• Obtained physician/administrative support for project.

• In serviced all staff on Save Our Skin (S.O.S) Program.– Skin assessment tools– Use of Braden Scale – Identification of pressure ulcer– Patient and family education

• S.O.S program piloted initially 3/03/08 including patient, family & staff.

Solutions Implemented

Rapid Cycle #1 1st & 2nd Quarter 2008


Num

ber

of N

osoc

omia

l Pre

ssur

e U

lcer

sSave Our Skin: Nosocomial Pressure Ulcer Incidence

5 NEWOctober 2007-September 2008

Octob

er 2

007

(N=5

2)

Nov

embe

r 20

07 (N

=49)

Dec

embe

r 200

7 (N

=50)

Janu

ary 20

08 (N

=48)

Febr

uary

200

8 (N

=57)

Mar

ch 2

008

(N=5

1)

April

2008

(N=4

7)

May

200

8 (N

=55)

June

200

8 (N

=53)

July 200

8 (N

=47)

Augus

t 200

8 (N

=49)

Sept

embe

r 200

8 (N

=53)

0

2

4

6

8

10UCL

Mean

SOS Project Implementation

Analysis of Outliers


Num

ber

of N

osoc

omia

l Pre

ssur

e U

lcer

sSave Our Skin: Nosocomial Pressure Ulcer Incidence

5 NEWOctober 2007-December 2008

Octob

er 2

007

(N=5

2)

Nov

embe

r 20

07 (N

=49)

Dec

embe

r 200

7 (N

=50)

Janu

ary 20

08 (N

=48)

Febr

uary

200

8 (N

=57)

Mar

ch 2

008

(N=5

1)

April

2008

(N=4

7)

May

200

8 (N

=55)

June

200

8 (N

=53)

July 200

8 (N

=47)

Augus

t 200

8 (N

=49)

Sept

embe

r 200

8 (N

=53)

Octob

er 2

008

(N=5

1)

Nov

embe

r 20

08 (N

=49)

Dec

embe

r 200

8 (N

=53)

0

2

4

6

8

10UCL

Mean



“Back To Bed” Reinforced

• Drill down 7 outlier cases for September 2008 to identify trends, common variables.

• Reeducate staff on S.O.S initiative. • Engage Physical Therapy staff in initiative.• Schedule patients “Back To Bed” • Monitor incidence of nosocomial pressure

ulcers on 5NEW.• Report outcomes to key stakeholders and

staff.

Solutions Implemented

Rapid Cycle #23rd & 4th Quarter 2008


Num

ber of

Nos

ocom

ial P

ress

ure

Ulc

ers

Save Our Skin: Nosocomial Pressure Ulcer Incidence5 NEW

October 2007-March 2009

0

2

4

6

8

10

UCL

Mean



“Back To Bed” reinforced

2 PU healed prior to discharge


Ra

te5 NEW Nosocomial Pressure Ulcer Rate

Academic and National BenchmarksMulti-Line - individuals

Nosocomial RateAcademic 75% PercentileBenchmarking Rehab MeanAcademic 10%

2 Q 200

6

3 Q 200

6

4 Q 200

6

1 Q 200

7

2 Q 200

7

3 Q 200

7

4 Q 200

7

1 Q 200

8

2 Q 200

8

3 Q 200

8

4 Q 200

8

0

5

10

15

20

25

30

Loyola 5 NEW

Goal: 0%


Solutions Implemented Rapid Cycle #3

1st Quarter 2009 • Monitoring healed pressure ulcers• Epic improvement: document type of cushion

for chair depending on type of pressure ulcer (chair, gel, roho)

• Encourage participation of Dietary Department in S.O.S.


Next Steps

• Monitor outcomes of S.O.S program• Measure number of nosocomial pressure ulcers that

are treated and resolved prior to discharge.• Monitor number of pressure ulcers Present on

Admission that are treated and resolved prior to discharge.

• Track admission source to 5 NEW.• Improve notification of healed ulcers to physicians. • Determine loss of revenue to Rehab due to a

nosocomial pressure ulcer. • Spread S.O.S. program to other hospital units.


Celebrate Success

• Staff celebrated the success of the November initiative and positive reinforcement given.

• Initiative continues, partnership with Physical Therapy grows.

• In order to maintain project sustainability, monitoring and information sharing among disciplines continues.

• Goal of zero nosocomial pressure ulcers achieved in November, December and January.

• Presented program to hospital board in January 2009• Issued a press release to consumer and trade publications

on December 16th, 2008.• S.O.S. posted on Loyola’s Website.• Article published in Advance for Nurses on February 16th,

2009.


Documents

Reduction of Nosocomial Pressure Ulcers on 5 NEW Rehabilitation Unit