Best Practices in Home Care:Pressure Ulcer Prevention

Background of the Pressure Ulcer Prevention Initiative• The importance of quality in wound management has

never been greater with the implementation of OASIS C. • Since the Fall of 2011, a total of four wound-associated

items, three of which are related to Pressure Ulcers, have been publicly reported on the Home Health Compare Website.

• Utilizing the Home Health Compare website, CMS is informing healthcare consumers of homecare agencies that conduct pressure ulcer risk assessment, communicate with physicians to obtain orders for pressure ulcer prevention and implement measures to reduce the development of pressure ulcers.

Pressure Ulcers Incidence in St. Luke’s Home Health Patients

Higher incidence of Increase in the Number of Pressure Ulcers

Chart audits revealed Pressure ulcers possibly missed at SOC Other wound etiologies mistakenly labeled as

pressure ulcers Inconsistent documentation of interventions for

patients determined to be at risk based on the Braden Scale

VNA of St. Luke's

Increase in Number of Pressure Ulcers January 2006 - June 2009

Source CASPER

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

VNA 1.32% 1.39% 1.07% 1.82% 0.72% 1.02% 1.28% 1.45% 0.61% 2.05% 1.15% 1.31% 0.89% 0.71% 1.00% 1.22%

Reference 1.00% 0.94% 0.96% 0.94% 0.92% 0.87% 0.88% 0.86% 0.86% 0.84% 0.85% 0.81% 0.81% 0.76% 0.81% 0.77%

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Problem

The VNA of St. Luke’s Home Health patients experienced a higher incidence of developing pressure ulcers compared to the national reference

Aim The VNA of St. Luke’s Home Health incidence

of pressure ulcers will be lower than the national reference by April 2010

Our PI Team

Two Wound Care Certified RN’s

One Home Health RN One Physical Therapist Home Health Quality

Manager Home Health and Network

Hospital Leadership

Our Plan… Develop a comprehensive pressure ulcer prevention

program that targets multiple factors that contribute to pressure ulcer formation Develop script for clinicians to use with patients to explain

importance of head to toe skin assessment Devise a consistent process when instructing patients on measures

to prevent pressure ulcers including use of a skin care product Add prompts related to pressure ulcer prevention to OASIS to

remind clinicians to educate patients at risk and to facilitate ease of documentation

Create resource tools containing pictures of pressure ulcers at various stages and guidance for OASIS M questions related to pressure ulcers

Educate staff through a train the trainer process based on clinician’s perceived need

Do…

Process Patients with a Braden Score of 18 or less received a free

prevention product• Purple cap for patients with “pretty” skin• Blue cap for patients in need of a “barrier” due to moist skin

Added check off boxes to OASIS to prompt clinicians to provide education patients at risk and to facilitate ease of documentation

Product Provided patients with a tangible product and had staff “show and

tell” about the product’s use lending credence to the importance of skin care

Do. . .

Pictures Developed resource tools containing pictures of

pressure ulcers at various stages and CMS guidance on answer pressure ulcer M questions on OASIS

People Added teaching handout on pressure ulcer

prevention to each admission packet Evaluated staff’s perceived knowledge of

pressure ulcer staging, prevention and product use as well as their ability to document OASIS C responses using a survey tool

Phase 3: CHECKVNA of St. Luke's

Increase in Number of Pressure Ulcers January 2006 - September 2010

Sources: CASPER/OCS

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

VNA 1.32% 1.39% 1.07% 1.82% 0.72% 1.02% 1.28% 1.45% 0.61% 2.05% 1.15% 1.31% 0.89% 0.71% 1.00% 1.22% 0.13% 0.68% 0.40% 0.10% 0.10%

Reference 1.00% 0.94% 0.96% 0.94% 0.92% 0.87% 0.88% 0.86% 0.86% 0.84% 0.85% 0.81% 0.81% 0.76% 0.81% 0.77% 0.75% 0.72% 0.80% 0.40%

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Phase 4: ACT

Develop and distribute body map containing location sites to promote consistent wound labeling

Develop and distribute wound product resource tool that describes product purpose and use for wounds of various etiologies including pressure ulcers

Questions…

VNA

Mission The Visiting Nurse Association of St. Luke’s, as part

of the St. Luke’s Hospital & Health Network, will provide compassionate, excellent quality, cost effective home health care, hospice services and home based parent/child programs.

VisionThe Visiting Nurse Association of St. Luke’s will be the Leader in Community Based Healthcare.