where oh where has our *puppy gone…

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Where oh where has our *PUPPY gone…..

*Pressure Ulcer Prevention Plan Yesterday

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Meet Our Nursing Home!

Quaint Home nestled in South Dakota’s back roads

50 Residents 55 beds

70 Caring Staff Members2 cats1 dog20 fish

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Our Quarterly Quality Improvement Team

Medical DirectorDirector of NursingESS Director (Safety)AdministratorConsulting PharmacistQuality Assurance Coordinator RN (rotates quarterly)C.N.A. (rotates quarterly)

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Our QI ‘Sub Team’

Team members from each department Led by QI coordinator Meet monthly Small committees beginning and ending within

this team

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Our Care Plan Team….

Director of NursingSocial ServicesMDS CoordinatorRestorative CoordinatorActivitiesDietary ManagerDay Shift C.N.A (rotates)Evening Shift C.N.A (rotates)

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Our Saga begins!

DON wondered how many of our nosocomial pressure ulcers currently have documentation for signs of Stage 1 pressure ulcers Worksheet A completed

• 5 Charts reviewed – 40% have documentation supporting Stage 1

– 60% have no documentation supporting Stage 1

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Help! We can’t do this alone!

A team is needed!An invitation was developed!

Posted • in bathrooms

• staff break rooms

• by time clock Inserted in pay checks

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Bored?

Lonely?

Want more fun?

Like to make a difference?

Care about pressure ulcers?

Want to help create excitement?

Stop by Susan’s office to find out more!

Invitation...

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Looking for excitement?

You’ve come to the right place!

A new pressure ulcer team is in the making!

You’re invited to join!

June 5, 2003 - 2:30 p.m.

Conference Room

Desire to make a difference necessary!

See you there!

Sign hanging in Susan’s office...

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Our Team Takes Shape!

C.N.A – EveningC.N.A. – DayQuality Improvement CoordinatorRN – DayRN – NightDietary AssistantActivities Assistant

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First Meeting!!

Guidelines set by team members• No finger pointing or blaming allowed!

• Weekly meetings every Tuesday at 2:30 pm– Goal of 60 minute meetings --eventually to 30 minutes

• Snack at each meeting - ask dietary!

• Keep notes of each meeting! - Note Taker needed!

• Start on time, end on time - Time Keeper needed!

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Celebrate small successes bulletin/story board --need volunteers!

No questions considered ‘dumb’ All ideas have equal weightHave Fun!!Keep meetings on task

need a leader!

No Negativity Allowed!

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Team Goal-Worksheet D

Increase the number of charts that reflect documentation of nosocomial Stage 1 pressure ulcers prior to development of nosocomial Stage 2 or Stage 3 pressure ulcers from 40% to 75% by July 1, 2003.

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Worksheet E – Current Process

Discrepancies noted in current process for pressure ulcers! Everyone has their own way!! Flow sheet created

• ‘Pressure Ulcer Prevention Flowchart’

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Taking it to the Fishbone!!

Worksheet G used as a guide Problem in process - pressure ulcers are not

reported until they are a stage 2 Ask why pressure ulcers are not reported until

they are a Stage 2.• Proceed with fishbone

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Why are pressure ulcers not identified until Stage 2 or 3?

EnvironmentEquipmentPeople

unaware of residents at risk unaware of Policy & Procedure if reported, no follow-up completed unaware of risks and signs of Stage 1

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Fishbone - Worksheet G Continued‘Why are pressure ulcers not identified until Stage 2 or 3?’

Methods/Processes No risk assessment No procedure

Materials Forms not available when needed

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Brainstorming Solutions - Worksheet H

Unaware of Policy & Procedure educate

Filing cabinet not in order organize

Forms not available when needed yellow sticky on master - educate staff to make copies

prior to running out!

If reported, no follow-up educate

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Solutions continued...

Unaware of residents at risk implement PUPPY pictures

No risk assessment Implement Braden Scale and protocols

No procedure for C.N.A.s to report implement PUPPY body cards

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Third Meeting!

Priorities Set!! Revise Policy & Procedure Risk Assessment Form PUPPY pictures PUPPY Body Cards for reporting Organize Filing System Staff Education

Gathering of examples and samples begins! Fellow nursing home teams Surf web

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Review Policy & Procedure

Include Braden Risk Assessment FormProtocols

Implementation Plan – Worksheet I used• Goal – All residents will have Braden completed by

Sept 30 – Begin with new admissions

– Weekly according to MDS schedule

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Review Policy & Procedure

PUPPY picture cards Implementation Plan (worksheet I)

• PUPPY cards will be implemented with Braden Scale. Nurse will place them when resident identified at risk per Braden Scale

• Evaluation – random 10% staff interview

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Review Policy & Procedure

PUPPY body cards Implementation Plan (worksheet I)

• C.N.A. will complete and Log

• Give to CN

• CN gives to MDS Coordinator after documentation and care plan updated

• C.N.A.s will receive education on 6/3/03

• Will discuss further at 6/3/03 meeting

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Fourth Meeting

PUPPY Rollout discussed PUPPY Fair

• Stations decided on

• Prizes

• Flyer designed

• Each team member volunteered for tasks

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We can prevent pressure ulcers!

Join us at the PUPPY Fair

to find out more!

June 15 - 1 p.m. - Dining Room

See you there!

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It’s coming!

PUPPY Fair

June 15 - 1 p.m. - Dining Room

See you there!

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Department Heads Needed!

QI Coordinator updates at weekly department head meetings each department head was given list of current

staff members in their department• contact staff members and ask if they’re planning to

attend the PUPPY fair

• if staff replies yes, a coupon is given to staff

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Name__________ Department__________

This coupon entitles bearer to: One free bag of puppy chow

Must be redeemed upon registration during

PUPPY Fair! Offer good only June 15, 2003

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PUPPY Fair Booths

PUPPY Picture Booth colored PUPPY pictures

• laminated and cut out poster explaining purpose and directions for use

Need a staff member to explain booth!

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Managing Moisture Booth

Incontinence products used to keep residents dry

Moisture barrier cream (if your home uses it) demonstration

Poster explaining importance of managing moisture

Nurse to explain booth

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‘Oh What a Relief it is!’ Booth

Sample of all pressure relieving devices currently used

Poster for booth Nurse to explain booth

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This Price is Right! Booth

Participants guestimate costs of pressure ulcers pressure ulcer prevention pressure ulcer treatments

A picture of a real wound and costs associated with healing could make a big impact on staff!

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Getting Picky With It BoothBooth set up with equipment

with cracks• infection control issues

• causing skin tears worn out

• no longer serving its purpose

Educate staff on the need to have equipment fit and be in good condition for our residents in order to prevent skin tears, pressure ulcers and infections

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Rolly Polly PUPPY Booth

Educates staff on our current turning schedule for residents at risk

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Food, Water and Pressure Ulcers Booth

Create awareness in staff Importance of snacks food intake importance of documentation special interventions

• colored napkins, or other ‘systems’ designed to alert staff to ‘at risk’ residents

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PUPPY Team Goals and Progress Booth

Storyboard or bulletin board‘Take the Pledge’ form for staff to sign

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How Much Pressure Does it take to Cause a Pressure Ulcer? Booth

Create awareness that it takes 60 mm to create a pressure ulcer dry skin and applying socks create sheering

• use onion and have staff apply sock!

• Use lotion and have them determine if it decreases sheering!

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Sheering Effects Booth

Increase awareness effects sheering has on residents’ delicate skin importance of preventing sheering

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Residents Skin is Just ‘Plum’ Thin Booth

Demonstrate how thin residents’ skin isIncrease awareness to use care with skin

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Fifth Meeting

Braden Scale education for nurses Braden Scale process and protocols set up

Filing system

Training Session for C.N.A.s set

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Questions?

QI ProcessArea in need of improvementCollecting DataBrainstormingPlanningImplementingFollow through